Application
Application Due July 13, 2015
Please remove all patient, provider, and organizationidentifiers. Maximum of five (5) Pages.Font: Calibri or Arial, 11 point
Evaluation Criteria
The AMGF Heart Failure Advisory committee will review each application and use the following criteria for acceptance into the collaborative.
- Committed Resources
- Ability to dedicate people and financial resources to the project
- IT plan and use of population registries
- Ability to build a multidisciplinary team
- Level of integration, partnerships, and collaborations
- Potential impact
- Number of patients impacted
- Innovation
- Feasibility, sustainability, scalability
Organizational Profile:Include an organizational profile that gives the reader an understanding of the size and scope of your organization without revealing your organization.
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Please address the following sections:
- heart failure Population Identification
- Define your population and how you identify them (e.g., ICD-9-CM diagnosis or CPT codes, Ejection fraction, HCC scores, other risk stratification models, etc.)
- How many patients with heart failure do you serve?
- How many sites serve patients with heart failure?
- Describe your current management of patients with hF
- Describe your current programs
- Inpatient, outpatient, transitions of care
- Who are your organizational partners (i.e. home care, SNFs, hospice,etc.?)
- Describe how the multi-disciplinary clinicians are engaged (primary care, cardiologists, nutrition, nursing, care manager, social work, pharmacists, hospitalists, etc.)
- What do you currently measure in your HF patients? (Readmission rates, beta blocker, ACE inhibitor use, etc.)
- Indicate your baseline data, if available
- How is the data shared within your organization?
- How frequently is it shared?
- Describe the tools and processes you use tolongitudinally monitor the patients in the outpatient setting ( care plans, tele-monitoring, diagnostics and labs)
- What educational materials do you utilize?
- Describe how your EHR is used to facilitate the care process.
- Describe your ideas for redesignIN the management of patients with HF:
- Whatchallenges or obstacles do you expect to encounter and how do you plan to address them?
- Describe the resources (people and Financial)that will be committed to the project:
- How do you plan to retrieve and analyze the data to track your performance?
Appendices
Cite and label the supporting documents in an appendix. It is highly preferred that supporting documents are clearly labeled as “Appendix 1,” Appendix 2,”etc. Maximum of five (5)Pages.