The Problem: Heart failure, a condition in which the heart can't pump enough blood to the body's other organs, is a major health risk for the mostly Latino population living in El Paso, Texas, near the border between the United States and Mexico.
At Del Sol Medical Center, a 336-bed community hospital in El Paso where three-quarters of the patient population is Latino, heart failure was the most common cardiovascular diagnosis. Yet heart failure patients were not receiving care in compliance with national guidelines, and they had high rates of hospital readmission.
Grantee Background: In an effort to improve care for heart disease patients, Del Sol Medical Center conducted an intensive review of its cardiovascular services, including an external audit, which provided a clear road map for improvement. With input from an interdisciplinary task force, the hospital initiated standardized procedures for diagnosing and treating heart attacks (e.g., dispensing aspirin and a beta-blocker at arrival and discharge) and other cardiovascular diagnoses.
Del Sol Medical Center also established a heart failure center intended to provide a bridge from inpatient to outpatient care. "We wanted to be more proactive in helping heart failure patients manage their disease so we didn't have a constant flow of patients being discharged and coming back again," said Jennifer Suitonu, MBA-HCM, MSN, RN, NEA-BC, administrative director of cardiovascular services. She also served as project director for Del Sol's project, funded by the Robert Wood Johnson Foundation (RWJF) under its national program: Expecting Success: Excellence in Cardiac Care.
A nurse practitioner ran the heart failure center, assisted by a nurse. Each day, the nurses reviewed hospital admissions to identify heart failure patients and begin educating them about the need to track their symptoms, control their diet, monitor their weight and blood pressure and take prescribed medications on an ongoing basis. The nurses also described the heart failure center and followed up within a few weeks after discharge to schedule a visit. Del Sol encouraged patients to bring family members and anybody else involved in their care to medical appointments.
The Project: Del Sol Medical Center improved its patient chart review and discharge processes, and enhanced its heart failure center, with support from Expecting Success. The initiative lasted from 2005 to 2008.
While working on Expecting Success, the Del Sol team:
The heart failure center:
Results: Del Sol Medical Center reported the following results from its Expecting Success project:
RWJF Perspective: RWJF is committed to ensuring that all Americans receive quality health care. Racial and ethnic disparities were especially likely to occur in treating heart disease, according to the Institute of Medicine. RWJF's Expecting Success national program engaged 10 acute-care hospitals in identifying cardiac care disparities and developing and sharing tools to improve care for African-American and Latino patients. RWJF focused Expecting Success on cardiac care because disparities are well documented and the recommended standard of care is widely accepted and easily measured.
"These hospitals courageously led the way in using data to discover and correct their own racial and ethnic gaps in care. Their hard work demonstrates that we cannot have high quality of care for all until providers see eliminating disparities in care as an essential function of mainstream quality improvement," said Pamela S. Dickson, MBA, assistant vice president for RWJF's Health Care Group.