By KELLY WILSON

Herald-Whig Staff Writer

Blessing Hospital has launched a project to improve the care of heart failure patients both in the hospital setting and after they are discharged.

The Heart Failure Care Improvement Project, which involves more than a dozen hospital departments, also is focusing on educating area residents about prevention and early detection of heart disease.

Blessing has been studying its care of heart failure patients and patient outcomes for more than a year to determine whether there are "some things we can do better," said Dr. Robert Merrick, medical director for quality management at Blessing.

"This hospital is really doing the hard work to improve care," said Dr. Steven Krause, interventional cardiologist at Blessing Physician Services. "You cannot improve (without looking) at your data and outcomes. It's ongoing, and we're moving in the right direction."

New data on the Hospital Compare Web site shows that the estimated 30-day death rate for heart failure patients is 14.2 percent at Blessing, compared with the national average of 11.1 percent. The death rate is the percentage of patients who die within 30 days after their admission to the hospital.

The percentages were calculated from Medicare data on patients discharged between July 1, 2005, and June 30, 2008. The Blessing figure is based on 694 heart failure patients discharged during that time. It does not include patients enrolled in Medicare Advantage plans or patients who don't have Medicare.

"The data appears to be accurate and statistically significant," Merrick said.

However, he added that while the percentages are risk adjusted for prior illnesses, the death rate does not take into account the severity of diseases in the community. He also emphasized that the 30-day death rate is a measure of the entire health-care delivery system, not just Blessing Hospital.

The ability to improve outcomes for heart failure patients will take "the hospital, the community, the patients and the outpatient facilities we have," he said.

Blessing conducted its own in-depth review of 124 Medicare patients treated for heart failure in a six-month period from Jan. 1 to June 30, 2008. Of those patients, 27 died in the hospital or within 30 days of discharge. Seventy-eight percent died after being discharged from the hospital. The patients who died were older and more likely to come from a long-term care facility, and they tend to be sicker, Merrick said.

"It's a complex disease, and it's a chronic disease," Merrick said. "There are a lot of things that play into how that patient does."

While some factors related to heart failure deaths are beyond the hospital's control -- the age of the patients, severity of their disease, other medical complications and whether patients follow through with treatment plans -- officials did identify areas in which the hospital could improve care.

The Heart Failure Care Improvement Project included physician and staff education and changes in computerized medical records to provide reminder prompts to ensure patients receive recommended care.

Merrick said that since those changes were implemented, Blessing's score on all national quality measures related to heart failure care improved:

* 98 percent of heart failure patients received recommended care, compared with 88 percent nationwide.

* 95 percent received documented discharge instructions and education, compared with 72 percent nationwide.

* 99 percent received a heart function evaluation, compared with 96 percent nationwide.

* 96 percent received appropriate medications, compared with 90 percent nationwide.

* 100 percent received smoking cessation education, compared with 99 percent nationwide.

"We're really quite proud of this," Merrick said. "We're trying to look at this as a prototype for a lot of disease processes."

Merrick also pointed to other improvements made in the last year. Heart and Vascular Center medical staff has increased to nine physicians, and a new three-month rehab program for patients was launched last year.

The hospital also provided more outreach programs with free or reduced cost health screenings for early detection of heart disease.

Blessing is considering adopting other measures to improve outcomes for heart failure patients.

"Overall we do a good job in providing the recommended processes in the hospital. But when patients move from one setting to another, care must be coordinated. We think there is some opportunity (for intervention after a patient's discharge)," Merrick said. "That care transition is so important."

Blessing provides detailed discharge orders, Merrick said, "but who follows up to make sure the recommendations are followed? Conceivably just a phone call can change that spiral."

Heart disease education in the community setting is another key.

"It's about changing the culture here locally and catching it early enough," Krause said, adding that patients in this area tend to put off seeking medical care.

-- kwilson@whig.com/221-3391