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Research ArticleMedical Practice

Congestive Heart Failure Clinical Outcomes Study in a Private Community Medical Group

Louis A. Civitarese and Nicholas DeGregorio
The Journal of the American Board of Family Practice November 1999, 12 (6) 467-472; DOI: https://doi.org/10.3122/jabfm.12.6.467
Louis A. Civitarese
From Preferred Primary Care Physicians, Pittsburgh. Address reprint requests to Louis A. Civitarese, DO, Preferred Primary Care Physicians, Scott Towne Center, 2101 Greentree Road, Suite B101, Pittsburgh, PA 15220
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Nicholas DeGregorio
From Preferred Primary Care Physicians, Pittsburgh. Address reprint requests to Louis A. Civitarese, DO, Preferred Primary Care Physicians, Scott Towne Center, 2101 Greentree Road, Suite B101, Pittsburgh, PA 15220
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Abstract

Background: Although angiotensin-converting enzyme (ACE) inhibitor therapy has been shown to improve clinical outcomes of patients with systolic dysfunction, it has been underused or prescribed in inadequate dosages by physicians in the treatment of congestive heart failure. Our goal was to evaluate whether integration of a clinical guideline within a continuous quality improvement program would improve care for patients with congestive heart failure caused by systolic dysfunction.

Methods: All patients of a private community medical group who were admitted to the hospital with congestive heart failure were studied prospectively for 21 months. An internally developed congestive heart failure practice guideline was presented to the group's physicians. The guidelines were available in the hospital computer system and were reinforced at monthly quality improvement meetings. Performance data were reviewed quarterly with the physicians.

Results: Rates of classifying systolic vs diastolic dysfunction remained unchanged during the study. Use of ACE inhibitor therapy at the time of discharge improved substantially for patients with systolic dysfunction. Quarterly admissions of patients with systolic dysfunction declined 49% throughout the study period. No improvement was noted in the documentation of specific discharge instructions.

Conclusions: Use of a disease management guideline, ongoing physician education, and feedback of peer performance data to physicians Significantly improved the quality and efficiency of care provided to patients with congestive heart failure in an independent, primary care medical group.

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The Journal of the American Board of Family     Practice: 12 (6)
The Journal of the American Board of Family Practice
Vol. 12, Issue 6
1 Nov 1999
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Congestive Heart Failure Clinical Outcomes Study in a Private Community Medical Group
Louis A. Civitarese, Nicholas DeGregorio
The Journal of the American Board of Family Practice Nov 1999, 12 (6) 467-472; DOI: 10.3122/jabfm.12.6.467

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Congestive Heart Failure Clinical Outcomes Study in a Private Community Medical Group
Louis A. Civitarese, Nicholas DeGregorio
The Journal of the American Board of Family Practice Nov 1999, 12 (6) 467-472; DOI: 10.3122/jabfm.12.6.467
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