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CHF Workgroup Discusses Value of Outpatient Intravenous Diuresis

CHF Workgroup Discusses Value of Outpatient Intravenous Diuresis

The Michigan Value Collaborative (MVC) holds bi-monthly virtual workgroups on six different clinical areas of focus. The goal of these workgroups is to bring collaborative members together to discuss current quality improvement initiatives and challenges. These six different clinical areas include chronic disease management (CDM), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes, joint, and sepsis. At the most recent MVC CHF workgroup, the discussion centered around inpatient versus outpatient intravenous diuresis for the acute exacerbation of CHF.

The prevalence of heart failure in the United States is increasing, with one study indicating it affects more than 5.7 million people. The study reports that up to 80% of patients with acute decompensated heart failure (ADHF) visit their emergency departments and that 91.5% of those patients were thereafter readmitted to the hospital for diuresis.

With increasing prevalence comes greater direct and indirect healthcare costs associated with CHF, accounting for approximately $40 billion annually in the United States. For patients over the age of 65, it is a leading cause of hospitalization with annual costs of $11 billion.

Despite significant costs and healthcare burden associated with this condition, the same study finds that no official guidance exists regarding an appropriate location for therapy. Since hospital readmission reduction programs seek to incentivize reductions in readmissions, it is important to simultaneously provide guidance to providers and patients on safe and effective options for outpatient treatment and therapy.

To address this concern, the workgroup discussed the benefits and safety of outpatient intravenous (IV) diuresis and how the outpatient administration of furosemide can be safe and effective. MVC members shared their experiences with setting up these clinics, their inclusion criteria, and other protocols. A standard diuretic protocol could include each patient being given an IV furosemide bolus with continuous infusion within the most appropriate outpatient setting, which could include the patient’s home or in a mobile clinic.

While in the outpatient setting, patients undergoing this treatment would be monitored via cardiac telemetry and appropriate blood panels before and after the infusion. Patients on maintenance medications are instructed to continue their standard dose in the outpatient setting as appropriate based on their individualized treatment protocol. Patients should follow up with their cardiology and primary care teams to maintain their treatment and care maintenance plans. Following the outpatient IV diuresis encounter, the study reported patients had lower costs, fewer hospital stays, and lower mortality risk than CHF patients who did not receive outpatient IV diuresis.

Overall, studies indicate that outpatient CHF IV diuresis treatment is a safe and effective method of relieving CHF symptoms with a low risk of adverse events. The MVC members in attendance had positive thoughts and experiences regarding outpatient IV diuresis clinics and would recommend further discussion on them. The outpatient mobile CHF diuresis clinic was of notable interest to the MVC members in attendance and will be considered for a specialty topic in future workgroups and blog posts.

The MVC Coordinating Center is interested in hearing how your organization is improving CHF patient care and reducing CHF hospital readmissions. If you would like to present at or attend an upcoming MVC workgroup, please contact the MVC Coordinating Center at the michiganvaluecollaborative@gmail.com.

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Introducing MVC Engagement Associate Chelsea Andrews, MPH

Introducing MVC Engagement Associate Chelsea Andrews, MPH

I would like to take this opportunity to introduce myself as the Michigan Value Collaborative’s (MVC) new Engagement Associate. As the Engagement Associate, I will work closely with the Site Engagement Manager and Site Engagement Coordinator to foster collaboration among members and other stakeholders and drive outreach efforts that facilitate statewide cross-institutional learning. I am excited to join the MVC Coordinating Center and look forward to getting to know our sites and members.

Colleagues would call me a well-versed health and wellness leader with an authentic and collaborative approach to program management who creates a positive and high-performing culture. I have worked in healthcare and health research in various capacities over the past 11 years, ranging from direct patient care to administration, and have co-authored multiple medical encyclopedia entries and actively contributed to NIH research. I’m a Michigan State University alumna with a pre-medical Bachelor of Science in human biology; a specialization in bioethics, humanities, and society; and a Spanish minor. After working as a nurse assistant in various specialties, I left the state of Michigan to earn my Master’s in Public Health in health systems, management and policy at the University of Colorado. While in Colorado, I was part of the administrative team for Colorado Medicine’s Department of Obstetrics and Gynecology - Division of Maternal Fetal Medicine. Since my return to Michigan in 2019 and prior to joining the MVC, I worked at the University of Michigan School of Nursing as Program Coordinator for the Alliance to Advance Patient-Centered Cancer Care, where I defined and executed project goals and acted as a liaison between the national program office teams, grantees, and board members.

I am passionate about comprehensive patient-centric operational procedures, community engagement, and reducing healthcare disparities. When I’m not working, you can find me playing with my dog and three cats, adventuring outside, working on cars, or reading next to a fire (I’m always accepting book recommendations). If you have any questions, please reach out to me at andreche@umich.edu.