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Milestones (colloquium) - Image

Dec 12, 2016, 09:30 AM
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Four Domains of Heart Failure

We work within the Continuum of Care model.
Healthcare clinicians in a meeting
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Battelle Healthcare Colloquium works within the Continuum of Care model. This model is the belief that care should extend from prevention to end of life. Awareness and prevention of heart failure activities begin in the community. After an individual experiences heart failure symptoms, they seek treatment or are admitted to a hospital. Their follow up care then is dependent on the expertise of clinicians. To discover and create new treatments and procedures we turn to science and research. These four areas – Community, Hospital, Clinician, Science – are the Four Domains of Heart Failure.

Community Domain Milestones

All individuals diagnosed with heart failure are members of the community. The earlier people at risk for developing heart failure can be identified, the more effective treatment will be. This is our greatest opportunity to impact their well-being.

It often falls on hospitals who have a kind of civic duty to make the community aware of heart failure. Yet, there is reciprocal responsibility of the community and individuals to respond as well. The Community Domain represents what lies outside of the hospital. 

Community Outreach Related Milestones

  • Increase the general awareness of the community at large
  • Early identification of individuals who have risk factors for heart failure 

Community Financial Related Milestones

  • Payors reimburse hospitals and clinical caregivers for treatments and services. It is important to understand how payors compensate hospitals and clinical caregivers. We need to look at compensation within the continuum of care using a chronic disease model.
  • The Medicare FIs are private insurance companies. They serve as the federal government's agents in the Medicare program including paying claims. They have two primary functions: reimbursement review and medical coverage review.
  • Key payors are non-Medicare fiscal intermediary insurance companies. They make up a large part of a hospital’s reimbursement.

Community Emergency Management Related Milestones

During their illness, almost all individuals with heart failure develop acutely decompensated heart failure. This requires emergency care. Often, emergency medical services (EMS) staff provide individuals with out-of-hospital acute care and transportation to the hospital. The hospital admits/readmits the individual to the emergency department. To achieve EMS milestones, the hospital emergency department/EMS should establish and maintain lines of communication.

Hospital Domain Milestones

Most patients receive care in a hospital when they experience acute decompensation. The emergency department is the most likely port of entry. These milestones include the entire hospital care process from arrival to discharge.

The entire care process is set by what happens to the patient during the emergency department triage and early assessment. Making an early heart failure diagnostic outlook decision is valuable when developing and using an emergency department heart failure acuity-based algorithm. It paves the way for early treatment and proper admission decision-making. It is an important step toward establishing a new organizational cultural norm.

Clinician Domain Milestones

Clinicians are at the heart of patient care. Their impact and influence is crucial to the well-being of patients. The Clinical Domain milestones focus on physicians, nurses and hospital staff.

Education of healthcare providers is a key element of heart failure accreditation. Hospital staff of all types need to know how to identify those at risk even if heart failure is not their main focus.

Science Domain Milestones

We discover new treatments and procedures for heart failure care through science and research. Heart failure research is the basis of the Science Domain milestones. Hospitals can realize best practices and improve care by participating in clinical studies. Contributing to the collective knowledge base advances the cause. It is a responsibility of all heart failure institutes.