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Home > "I" Clinical Trials Conditions > Innovative Strategies for Implementing New CHF Guideline Recommendations  Innovative Strategies for Implementing New CHF Guideline Recommendations
Innovative Strategies for Implementing New CHF Guideline Recommendations
For Condition: Heart Failure, Congestive
Status: Completed
Sponsor(s): Department of Veterans Affairs ,
Synopsis: Clinical practice guidelines are an important avenue for improving health care quality and outcomes, but adherence is often suboptimal. CHF guidelines have recently been revised to incorporate the widespread use of beta-blockers, thus providing a unique opportunity to evaluate strategies for implementing this new recommendation. The initial objective of this proposal is to determine the best strategy to implement beta-blocker therapy in appropriate CHF patients. The long-term objective will be to validate the most effective strategy in a diverse group of VA facilities. In the initial phase, the usual approach, intensive provider education and guideline promotion (the Control group), is being compared to a Provider notification/Patient empowerment strategy that utilizes timely computerized reminders and involves the patient in this aspect of their care, and Nurse Case Management that utilizes a specially trained and supervised nurse practitioner to initiate and titrate beta-blocker therapy. Prevalent CHF patients who were appropriate candidates for beta-blockers were identified and assigned to one of the strategies based on a randomization of their primary provider. The most successful strategy will be determined by the proportion of appropriate patients initiated and maintained on beta-blockers as the primary outcome measure. Secondary outcomes include the proportion achieving target doses, the number of patients deteriorating during initiation, and provider and patient satisfaction with these interventions. In the Implementation/Validation Phase, the most successful strategy in a Level 3 hospital (San Francisco) will be applied to a Level 2 facility (Reno VAMC) and 2 large outpatient clinics of the NCHCS (Martinez and Sacramento/Mather), with the goal of initiating at least 70 percent of appropriate CHF patients on beta-blockers.
Details:
Eligibility:
Study Type: Interventional, Treatment, Randomized, Open Label, Active Control, Parallel Assignment
Minimum Age/Maximum Age: 18 Years/
Genders: Both
Protocol Entry Criteria: - Chronic heart failure - Systolic left ventricular dysfunction (ejection fraction less than or equal to 45%) - Not receiving beta-blockers - No contraindications to beta-blockers.
Total Enrollment: 60
Location and Contact Information:
VA Palo Alto Health Care System
Palo Alto, California, 94304-1207
United States
San Francisco Medical Center
San Francisco, California, 94121
United States
Additional Information:
Study ID Numbers: CHI 99-063;
Study Start Date: October 1999
Record last reviewed: November 2000
Additional information available at: clinicaltrials.gov
Clinicaltrials.gov Reference link: NCT00012974
Other Heart Failure, Congestive Studies:
1. Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE)
2. The Role of Angiotensin Type I Receptor in the Regulation of Human Coronary Vascular Function
3. Effect of Behavioral Management on Quality of Life in Heart Failure
4. Management of Patients with Congestive Heart Failure After Hospitalization
5. Genetic Architecture of Heart Disease in Rural Brazil
Related Studies:
Other Heart Failure, Congestive Clinical Trials
Other California Clinical Trials
Other Palo Alto Clinical Trials
Innovative Strategies for Implementing New CHF Guideline Recommendations
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