Impact of a guideline-based disease management team on outcomes of hospitalized patients with congestive heart failure

Background: Congestive heart failure is the most common reason for hospital ization in the United States, and guidelines to improve the quality of care for patients with congestive heart failure have been developed. However, a dherence is typically low. We hypothesized that a guideline-based care mana gement team would result in greater quality and efficiency of care than gui delines alone. Methods: A faculty cardiologist and nurse care manager at an academic medic al center reviewed each patient's data and made guideline-based recommendat ions. Hospital length of stay, total costs, and use of recommended guidelin es were compared between 173 patients before team implementation but with a vailable guidelines, 283 care-managed patients, and 126 concurrent non-care -managed patients. Results: Care-managed patients achieved higher rates of use of angiotensin- converting enzyme inhibitor than baseline or non-care-managed patients (95% , 60%, and 75%, respectively; P<.001), as well as increased adherence to gu idelines for daily weight monitoring and assessment of left ventricular fun ction. Hospital length of stay was lower (median, 3, 4, and 5 days, respect ively; P<.001) as were costs of hospitalization (median, $2934, $3209, and $4830, respectively; P<.01). These differences persisted after adjustment f or severity of illness. Conclusions: When compared with dissemination of guidelines alone, an activ e care management approach was associated with significant improvements in quality and efficiency of care for hospitalized patients with congestive he art failure.