Reducing health care disparities at Sanger Heart and Vascular Institute

The challenge: Patients with socioeconomic barriers experience decreased access to care. This can lead to untreated cardiovascular disease and negative health outcomes.

The innovation: The Sanger Heart and Vascular Institute created a mobile program in which underserved populations could receive screenings, food assistance, and cooking tutorials, as well as make appointments with providers. The mobile clinic visits patients in community locations and helps resolve transportation issues and other barriers to care.

The impact: Over 100 people are regularly seen through the program, and many have experienced weight loss and blood pressure reductions. Through the program, patients have become engaged in their medical care and have been able to make appointments with primary care providers and cardiologists.

Holographic therapy guidance

The challenge: With the rapid expansion of cardiac transcatheter therapies, there is an emerging need for improved intraprocedural image guidance. Transcatheter cardiac devices are currently implanted under two-dimensional image guidance, which poses a challenge to cardiovascular teams who use these images to interpret four-dimensional structures.

The innovation: CentraCare worked with a medical technology company to develop a holographic therapy guidance system that can convert ultrasound images into 4D holograms. This allows for real-time assessment of patient-specific anatomy, rather than reliance on 2D images.

The impact: Interventional cardiologists at CentraCare have done approximately thirty procedures with their holographic technology. It has allowed them to have greater visibility during left atrial appendage occlusion procedures and has promise for application in more complex structural heart procedures.

Congestive Heart Active Management Program (CHAMP^®)

The challenge: Heart failure patient management between the inpatient and outpatient settings can be disjointed, meaning patients can lack the support and resources they need to manage their care. Underserved patients with psychosocial factors can find self-management in these instances especially challenging.

The innovation: The Dignity Health Heart and Vascular Institute created an on-campus, heart failure-focused call center staffed by cardiovascular nurse navigators. The navigators follow up with heart failure patients at regular intervals after discharge to educate them on managing their conditions and medications.

The impact: Nearly 2,000 patients in Northern California are currently served by CHAMP^® nurses. The program has led to an 80% decrease in readmission rates and a 60% average reduction in inpatient costs.

ECMO referral call

The challenge: During the Covid-19 surges, Memorial Hospital of Carbondale experienced an influx of emergency referrals for ECMO and lacked open bed availability.

The innovation: Memorial Hospital of Carbondale set up a process for quick, multidisciplinary patient management for ECMO candidates. Their switchboard relays an Informacast notification that includes a conference call link to the ECMO team and referring provider, who develop a collaborative treatment plan. The referral link is used to gather the team together again once the accepting bed and provider is established.

The impact: With this process, ECMO referrals greatly increased, and collaboration between CT surgeons, interventional cardiologists, and pulmonologists improved. Importantly, consultations for possible emergent ECMO procedures were able to happen in a timelier manner.

The heart failure OPTIMIZE clinic

The challenge: Heart failure patients experience high readmission rates. This is especially due to suboptimal adherence to guideline-directed medical therapy.

The innovation: The OPTIMIZE clinic at Nebraska Medicine is an advanced practice provider-driven outpatient clinic that provides medication management, self-management education, and pharmacy and dietician access to heart failure patients. During the six-visit program, patients are also screened for comorbidities and referred to appropriate specialists.

The impact: 100 patients completed the OPTIMIZE clinic program between October 2018 and December 2020, leading to 34 specialist referrals. The 30-day readmission rate for participants is 1.8%, compared to the hospital-wide rate of 13% in 2019.

Shared medical appointments in cardiopulmonary rehab

The challenge: Promoting sustainable health behavior changes in patients can be difficult, even among patients who undergo cardiac rehabilitation.

The innovation: St. Luke’s implemented shared medical appointments that address St. Lukes’ “six pillars of lifestyle” in a holistic approach for cardiac rehab patients. The group appointments are delivered by a medical provider in conjunction with a licensed clinical social worker.

The impact: Patients who participate in the shared medical appointments have demonstrated above average weight loss, peak exercise activity levels, and high quality of life scores. Many are at goal for cholesterol, blood pressure, and blood sugar levels.

CARDIO program at the Asian Health Coalition

The challenge: Asian Americans have high risk of cardiovascular disease at lower weights compared to other patient populations. However, there is limited culturally-tailored health education meant specifically for Asian ethnic groups.

The innovation: The Cardiovascular Awareness Recognizing Diet and Integration of Exercise Options (CARDIO) Program offers linguistic and culturally competent heart health education to South Asian and Chinese individuals in the Chicago area. Participants engage in monthly programming about nutrition, exercise, smoking, coping with stress, and behaviors that reduce risk for heart disease.

The impact: 325 people have participated in the CARDIO program, 54% of whom lost weight. Six months after completing the program, participants continued to maintain healthy diets and high levels of physical activity.

Development of a heart failure hospitalist program

The challenge: Hospital readmissions are common among heart failure patients. This poses a significant burden to the health care ecosystem.

The innovation: Harrisburg Hospital’s cardiologists and hospitalists partnered to create a heart failure hospitalist program in which clinicians are notified about admitted heart failure patients and round on them at least three times a day to build relationships. During their rounds, the hospitalists provide comprehensive education and aggressive medication regimens and discuss goals of care.

The impact: After the implementation of the heart failure hospitalist program, 98% of Harrisburg Hospital’s heart failure patients were on guideline-concordant care. On average, their length of stay and cost per case decreased, and their 30-day readmission rate was reduced by 8.35%.