The CHF Program is based on the Institute for Clinical Systems Improvement (ICSI) CHF in Adults Guideline (2002 version) from the AHCPR CHF Guideline (now AHQR) and the American College of Cardiology/American Heart Association Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult (2001).
The following is a description of the CHF program and its elements.
Program Goals
The primary goal of the CHF program is to optimize the care of members with CHF while achieving the highest possible quality of life through the following:
- Incorporation of the CHF Clinical Guideline into a comprehensive health management program.
- Promotion of baseline cardiac imaging and a reduction of repeat studies of ejection fraction, since clinical management of congestive heart failure is based on patient history and physical examination.
- Promote the use of ACE inhibitors in patients with systolic dysfunction and beta-blocker therapy in patients with CHF.
Interventions
Care Coordination nurses work with health care providers and rely on the following interventions when working with Health Plan members enrolled in the CHF program:
- Comprehensive CHF assessment and risk factor stratification.
- Individualized self-management education: medication management, diet modification, fluid management, and early identification of worsening condition.
- Collaboration with health care provider to obtain cardiac imaging and optimal medication management.
- Health promotion services–influenza and pneumococcal administration as indicated.
- Data analysis to support clinical management–percent of members with cardiac imaging, percent of members on Beta-blocker and ACE therapy as indicated.
Program Referral
To refer a Health Plan member to the CHF Program, please call (800) 883-6355 or (570) 271-8763 between 8 a.m. and 4:30 pm.
References
1. Institute for Clinical Systems Improvement (ICSI) CHF in Adults Guideline (2002 version) from the AHCPR CHF Guideline (now AHQR).
2. American College of Cardiology/American Heart Association Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult (2001).
