Heart failure (HF) affects a significant and growing number of Americans and carries a considerable cost to society. The incidence and cost of HF continues to increase with HF being the most common cause of hospitalization in the United States. Cost estimates for HF in 2008 are $69.4 billion dollars. HF care delivery has been identified by the author’s healthcare system as a major strategic concern. Within this health care system there was no formal process in place for coordination of disease management and implementation to goal of evidence based therapies (EBT) for the HF population. The author, along with leaders from this health care system determined a need for better coordination and use of EBT for this patient population. Multidisciplinary care, use of proven pharmacologic and non-pharmacologic therapies, nurse directed education and intervention have been shown to be effective in reducing readmission and improving quality of life (QoL) of the HF patient and have been reported in the literature. In this paper the development and implementation of a nurse practitioner (NP) facilitated and managed heart failure clinic which provided comprehensive, coordinated, evidence based care for this patient population is presented, also in this paper is a discussion of the patient outcomes as a result of participation in this disease management HF clinic. This Capstone Project consisted of a quality improvement project which examined the impact of an NP facilitated and managed HF clinic on adherence to evidence based guidelines for HF on use of proven therapies, QoL, and readmissions and was implemented at a large referral center hospital with adult HF patients considered for participation. These patients were followed in the HF clinic by NPs working in collaboration with HF subspecialist cardiologists and received individualized, intensive education on self care strategies and risk factor modification. Participating patients also received medical management of their HF in order to better coordinate care and increase the use of EBT. This author chose to use Bandura’s self efficacy theory as a theoretical framework for this project as self care strategies are based on theories of self efficacy. For the evidence based practice model this author selected the Rosswurm and Larrabee model to use as the framework for the development and implementation of this clinic. This author proposed that NP facilitated care of this patient population would prove to be effective at decreasing readmission, improving QoL and, improving use to goal of proven therapies. The results demonstrated thus far have been supportive of this assumption as use of EBT and QoL increased and readmissions decreased as a result of participation in this disease management HF clinic. The author believes that this practice change with a solid foundation in evidence based practice has proven effective and should be expanded throughout the author’s health system. Recommendation is also made to use this clinic as a model for other chronic diseases in order to improve outcomes for other populations of patients.
