Automating Heart Failure Data for Patient Treatment Goals at the Point of Care

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DESCRIPTION (provided by applicant): VA Project Summary Garvin 2011: Greater than 90% of Veterans with congestive heart failure (CHF), a high prevalence, high impact disease in veterans, are given guideline-recommended medications at the time of inpatient discharge, yet beta blocker medications are often not at optimal doses. Patients with CHF have better symptom management and survival when treated in accordance with the guideline-recommended dosage of beta blocker that was used in randomized clinical trials. Our preliminary analyses from the Veterans Integrated Service Network (VISN) 12 show that almost one half of the patients with history of CHF are not on a beta blocker. In addition, the doses of beta blockers prescribed for patients with CHF are only half of those recommended by the guidelines. Titration of medications to the guideline concordant doses should be timely and the outpatient follow-up in the Patient Aligned Care Teams (PACT) is the ideal setting to undertake titration. We propose to develop an automated communication aid for use at the point of care (POC) with PACT teams and to examine the impact of its use on CHF care. We will use innovative informatics techniques, including information extraction (IE) and natural language (NLP), techniques coupled with an Implementation Science (IS) approach in this proposed study. We define POC within the context of PACT as any setting where a provider evaluates clinical information and makes a care decision. We will implement this aid with a secure communication system in PACT teams at the study facilities within VISN 12. To this end, in partnership with our PACT and VISN 12 stakeholders, we will use facilitation techniques from the Promoting Action on Research Implementation in Health Services (PARIHS) IS model to identify the most appropriate data elements to prompt beta blocker titration and the best way to present them to PACT providers using our communication aid. We will determine the clinical and cost effectiveness of the use of the communication aid in a clinical trial. Our primary goal is to improve beta blocker titration according to guideline-recommended care thereby reducing patient readmissions and improving patient outcomes. The research proposed is one of four projects developed in partnership with the Houston Center of Excellence as part of the Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE).