Blueprint for Valve Centers

Building the Infrastructure to Support Multidisciplinary Valve and Transcatheter Valve Programs

Topics: Cardiovascular, Service Lines, Market Trends, Strategy, Technology Assessment, Planning, Service Line Growth, Volume Growth, Vascular

Program Profile: Riverside Methodist Hospital and OhioHealth Research Institute

TAVR Trial Catalyzes Center Development

Joint Effort Between CV Service Line and Research Department

Contrary to Reading, Riverside Methodist Hospital, an 826-bed teaching hospital in Columbus, Ohio, built its Structural Heart Disease (SHD) Center with the goal of pursuing TAVR.

After being identified to participate in the Medtronic CoreValve trial in March 2010, Riverside realized it would need to create a formal disease center to provide the foundation for multidisciplinary, cross-continuum valve care.

To begin this process, the CV service line partnered with OhioHealth’s Research Institute to launch the Riverside SHD Center. Over the next 11 months, they jointly developed an infrastructure to support the TAVR program, and were prepared to perform their first procedure in February 2011.

The collaborative development process facilitated an ongoing partnership between the research team and CV service line. This proved critical in supporting the launch of a commercial TAVR program at the SHD Center. More specifically, once the Edwards SAPIEN valve was approved for commercial use in November 2011, Riverside was able to build a SAPIEN program within the existing SHD Center infrastructure in just a few months.

Timeline of Riverside's Structural Heart Disease Center

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Program in Brief

Riverside Methodist Hospital's Structural Heart Disease Center

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A Robust Infrastructure for Multidisciplinary Care

Hardwiring Multiple Opportunities for Collaboration

Recognizing the importance of ensuring multidisciplinary collaboration in valve patient care, the SHD Center provides several opportunities for collaborative discussions around clinical and operational aspects of the TAVR program. These include meetings immediately before and after each TAVR case, for an indepth clinical review. Additionally, the SHD Center holds bimonthly open forums to offer program updates and education to hospital staff and physicians outside the immediate TAVR team, as well as get feedback on program strategy and operations.

Multidisciplinary Case Conference

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Emphasizing Collaboration with Non-invasive Imaging

Building a Fundamental Partnership with Radiology

Riverside’s emphasis on multidisciplinary collaboration applies to ancillaries as well. As TAVR relies heavily on noninvasive imaging in screening, procedure planning, and follow-up, the SHD Center focuses on enhancing its partnership with non-invasive imaging. For example, to increase screening efficiency, the TAVR clinic takes place near the echo lab. The SHD team also helps select and train TAVR echo techs, and engages non-invasive labs in performance improvement initiatives. Together, these efforts have ensured quality and availability of imaging at the SHD Center.

Key Factors Optimizing Imaging Use at SHD Center

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A Joint Imaging Protocol for Both CoreValue, SAPIEN

Streamlining Screening with Combined Imaging Worksheet

Another strategy that has had considerable impact on enhancing imaging’s role in TAVR patient care has been development of a standard TAVR imaging worksheet. When Riverside began using SAPIEN as well as CoreValve, they found slight differences in imaging protocols between the devices. To mitigate confusion, the TAVR team collaborated with echo and CT experts to create a combined worksheet for each modality. This has streamlined screening and reduced the need for repeat imaging due to missed measurements.

Echo, CT Screening Protocols Differ by TAVR Vendor

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Garnering Hospital-Wide Support for Resource-Intensive Program

Successful Strategies for Cultivating Hospital Engagement

Outside of imaging, the SHD Center also acknowledges the importance of engaging other individuals beyond the TAVR team, given the widespread impact of the program on the hospital. For example, they have designated sub-specialist physician champions to adopt a formal role in the SHD Center. Another tactic that, while seemingly simple, has been very effective is a TAVR update email sent to all interested hospital staff. This engages the whole hospital in the program’s successes, which helps garner support from staff whose workflow may be impacted by TAVR.

Increasing Volumes Since Valve Center Launch

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Engaging Referrers Across Entire Care Pathway

Going Beyond Traditional Outreach to Strengthen Referral Network

Riverside also extends this collaborative approach to referring physicians, employing several strategies to strengthen their referring physician network. In addition to providing TAVR education opportunities, they strive to engage referring physicians throughout the entire care process. This ranges from including them in valve case conferences to inviting them to observe procedures in the hybrid OR. As a result of these tactics, physicians are more likely to refer again in the future and are better equipped to provide follow-up care.

Referring Physician Involvement in All Stages of TAVR Care

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Realizing the "Halo Effect" of the SHD Center

Positive Impact of Program Felt Throughout Health System

As a result of these collective efforts, Riverside has become the hub for high-end valve services in their community. They have also clearly experienced a “halo effect” from the SHD Center, with a 16% increase in overall valve surgery volumes since the center began, and an $8 million per-year contribution margin from downstream services yielding from TAVR screening. In sum, Riverside’s SHD Center has effectively implemented research-based and commercial TAVR, leveraging a comprehensive approach to collaboration with all involved parties to ensure ongoing success.

Regional Referral Center for High-End Valve Services

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Program Profile: Reading Hospital

Program Profile: MUSC Health