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Using Lean to Enhance Heart Failure Patient Identification Processes and Increase Core Measure Scores

Hunt, Jennifer R., MPH, CMRP (AHA-CC), RHA/ACLFA; Ouellette, Kelli Jo, BSN, RN, MS; Reece, Michelle, DrPH

doi: 10.1097/NCQ.0000000000000330
Original Article: PDF Only

Background: Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. Health systems target readmission rates for quality improvement and cost reduction.

Local Problem: Heart failure core measure (CM) scores at our medical center were lower than the national average, and methods for capturing the appropriate documentation on HF patients to ensure CM compliance were not clear.

Methods: An interdisciplinary team determined barriers to increasing CM scores, gathered baseline data, and identified gaps in the existing process.

Interventions: The team implemented an accurate reporting system and error-proofing process, redesigned the process for identifying patients admitted with a HF diagnosis, and developed a patient appointment section before discharge in the electronic medical record.

Results: There was a decrease in readmissions within 30 days of implementation from 12% to 8%, and HF CM compliance score increased from 88% to 100%. The percentage of HF patients not identified during hospitalization decreased from 17% to 0%. Heart failure patients discharged with a 7-day follow-up appointment increased from 88% to 98%.

Conclusion: Through implementation of an interdisciplinary-led process improvement and lean methodologies, metrics and CMs were achieved.

Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City (Ms Hunt); Intensive Care Unit, Johnson City Medical Center, Johnson City, Tennessee (Ms Ouellette); and Department of Public Health, College of Health and Human Services, Western Kentucky University, Bowling Green (Dr Reece).

Correspondence: Jennifer R. Hunt, MPH, CMRP (AHA-CC), RHA/ACLFA, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, 104 Lamb Hall | Box 70623, Johnson City, TN 37614 (

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: January 18, 2018

Published ahead of print: June 14, 2018

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