Use of a clinical care map for the management of congestive heart failure in a community hospital

BACKGROUND. Managed care rewards those individuals and institutions capable of achieving superior patient outcomes while making wise use of limited resources. However, studies of patient outcomes under these circumstances are lacking. We sought to investigate whether decreasing length of stay and limiting resource utilization had a negative effect on objective measurements of patient outcome for patients with congestive heart failure. METHODS. Guided by studies of evidence-based medicine, a multidisciplinary team developed and implemented a clinical care multidisciplinary action plan for the inpatient management of congestive heart failure. This provided practitioners with a target length of hospital stay, projections for daily improvements based on intervention, guidelines for diagnostic studies and medical therapy, early identification of patients with special discharge needs, and intensive patient education. RESULTS. Shorter lengths of stay for patients with congestive heart failure were achieved without negatively impacting on mortality or readmission rates. The study found a trend in favor of greater utilization of appropriate medical therapy despite shorter hospitalization. CONCLUSION. The use of a clinical care map for management of complex medical illnesses can be associated with shorter hospital stay without sacrificing patient outcomes. (c)2001 by CHF, Inc.