Project Charter
PLEASE NOTE. THIS PROJECT:
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Part 1 |
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| Project Charter Information | |||||||||||||||
| Project Name | Implementing Evidenced Based Palliative Focused CHF Protocol for Advance
Practice Clinicians in Long Term Care |
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| Project Site | Optum-United Health Group | ||||||||||||||
| Contact at site | Name with credentials: Adrienne Peart APRN, NPC, Clinical Service Manager.
Organizational Email: Phone Number: |
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| Preceptor | Name with credentials: Lora Crowe, PHD, Senior Clinical Service Manager.
Email: Phone Number: |
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| Executive Sponsor | The executive sponsor is Adrienne Peart APRN, NPC, a Clinical Service Manager at Optum. The reason for selecting the sponsor is the extensive experience in handling patients with complex health needs. The manager also coordinates efforts by advance practice clinicians and monitors outcomes to ensure that services provided match patients’ needs and expectations. | ||||||||||||||
| Gap Analysis | Optum Health is a subsidiary of the United Healthcare Group responsible for providing healthcare services to those who are insured by United healthcare insurance products. Therefore, the strategic priorities of Optum health reflect the corporate mission and core values that align with the broader United Health Group (UHG) vision of improving customer experience by making healthcare work better for everyone by helping people live healthy lives. The strategic priorities of UGH-Optum health for 2021 includes expanding access to preventative care services to 85% of its customers by year 2030, shifting 55% of outpatient surgeries to a high-quality, cost-effective setting by year 2030 and closing 600 million gaps in care for customers by the 2025 (UHG, 2020). Undoubtedly providing affordable, quality, safe, and effective patient care set precedence and is the number one priority of UHG. Achieving high-quality outcomes, lower costs, and improved consumer and physician satisfaction, driven by our high-performing local care practices. UHG have the focus of efficient and profitability of the services provided by the organization, low-cost services is a priority.
The problem at the practice site is the lack of use of an evidenced-based protocol for APCs to proactively manage members with CHF with reduced ejection fraction in long-term care. Even though some patients are managed by a cardiologist and have echocardiograms, they are not readily available to the APC at the skilled nursing facilities. However, the skilled nursing facilities become the patient’s medical home under the management of Optum APC. Therefore, the Optum APC can manage the polypharmacy and CHF regimen per AHA guideline. |
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| Evidence to Support the Need | Ten patients with heart failure with reduced ejection fraction diagnoses were selected, reviewed, and compared with AHA guidelines. None of the charts audited had ARNI (angiotensin receptor-neprilysin inhibitor) known as Entresto is part of the AHA recommendation for management of heart failure with reduced ejection fraction. Four patients with African American (AA) heritage are not on Hydralazine and only one patient was one SGLT2i as indicated by the guideline (Heidenreich et al., 2022). All ten charts reviewed had full code status indicating a lack of understanding of disease trajectory and recommendations (Mechler & Liantonio, 2019). | ||||||||||||||
| PICOT | In advanced practice clinicians in complex care management at Optum (P) implementation of CHF palliative care protocol (I) compared to No heart failure protocol (c) to measure APC compliance with CHF protocol for patients in long -term care (O) within 10 weeks(T) | ||||||||||||||
| Project Aim | The aim is to streamline Advanced Practice Clinicians use of palliative care protocols for CHF patients at Optum. The project seeks to enhance the implementation of AHA guidelines for Advanced Practice Clinicians (APC) handling members with NYHA class IV heart failure in the long-term care. The anticipated impact is that the guidelines with enhance compliance with guidelines established to safeguard patients from severe complications and premature death. The intervention will address gaps in using evidenced-based protocols for APCs to proactively manage members with CHF w
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