Perspectives from Geriatric In-patients with Heart Failure, and their Caregivers, on Gaps in Care Quality

BACKGROUND: Evidence indicates that care experiences for complex HF patients could be improved by simple organizational and process changes, rather than complex clinical mechanisms. This survey identifies care gaps and recommends simple changes. METHODS: The study utilized both quantitative and qualitative methods at The Ottawa Hospital, Geriatric Medical Unit (GMU) during a three-month period. RESULTS: Nineteen patients (average age 85, 12 female) surveyed. Twelve participants lived alone. Fourteen lived in own home. Four patients had formal home-care services. Fifteen relied on family. Gaps were identified in in-patient practice, discharge plan, and discharge summary implementation feedback. Only five participants had seen a cardiologist or a specialist. Half of the patients did not know if they were on a special Heart-Failure (HF) diet. Participants did not recall receiving information on life expectancy but were comfortable discussing EoL care and dying. HF-specific management recommendations were mentioned in only 37% of discharge summaries to primary care providers (PCPs). CONCLUSION: The results provide the starting point for a quality assurance and process re-engineering program in GMU. Organization change is needed to develop and integrate a cardiogeriatric clinical framework to allow the cardiologist, geriatrician, and PCP to actively work as a team with the patient/caregiver to develop the optimal care plan pre- and post-discharge.