The overall purpose of this project, for which funding to support the planning and feasibility study is requested by this application, is to develop a structured approach for the implementation of evidence-based guidelines for inpatient cardiac care. Literature indicates that the use of such guidelines can decrease length of stay in the acute setting and shift care to outpatient venues, with commensurate decrease in cost. However, literature also supports the difficulty of implementing new models of care. This project will have 4 major aims: (1) To develop through the partnership an evidence-based model for comprehensive Heart Failure (HF) care that can be readily adopted by each CHP region and incorporated into existing activities; (2) To adapt the interventions of the ACC's Guidelines Applied in Practice (""""""""GAP"""""""") project for improving AMI care to HF care; (3) To implement information technology applications, including computerized physician order entry (""""""""CPOE"""""""") systems that support the first and second aims, especially in the context of managing a chronic disease state such as HF, and (4) To demonstrate the ability to establish and sustain effective, broad-based partnerships among a variety of diverse health care organizations, provider groups, professional medical societies and health care information technology corporations and their stakeholders. Two aspects of implementing guidelines will be examined during the planning phase. First, the study team will examine knowledge sharing frameworks and propose a specific framework to serve as the model for the educational and implementation approach. Among the models to be examined are, for example, trans-theoretical frameworks for the adoption of change and Dixon's """"""""common knowledge"""""""" framework concerning the structure and process of knowledge transfer. The second aspect of guideline adoption to be examined includes the role of technology in facilitating change and supporting practice. The multidisciplinary project council, including representatives from an health information technology company (McKesson), will examine the feasibility and cost-effectiveness of programming the selected guidelines into existing and new computerized physician order entry and other IT tools. Objectives for phase I of the project include: adaptation of specific HF guidelines and associated measures for the Catholic Health Partners system, consisting of 31 hospitals located in 5 states (which discharged over 8,000 patients with HF during calendar year 2001); development of a knowledge transfer framework with which to structure implementation of the guidelines; and the development of a prototype for the CPOE. At least two hospital sites will serve as the pilot sites, participating in the development of the implementation approach, and testing the implementation protocols and the use of the CPOE. Based on the findings of the planning phase, additional sites will be added in phase II, during which we will make revisions to the software and protocols based on phase I results, and implement the revised information technology-assisted approach.
