Development of Multidisciplinary Care Model With Participatory Action Research for Heart Failure Clinic in Bangkok, Thailand

Abstract

Background : Quality of care improvements is a challenge when resources are limited. In this participatory action research (PAR) study, we created a multidisciplinary care model (MCM) for heart failure clinic at a hospital in Bangkok, Thailand, and evaluated quality performance measures and clinical outcomes. Methods : Using the PAR framework, this study included: 1) identi fi cation of problems and planning solutions with providers, 2) development of the MCM, 3) implementation of the MCM, 4) evaluation of quality process and outcome measures among heart failure patients at the follow-up conducted 6 months after implementation of the MCM, and 5) post-MCM survey. Results : Information management of patient data, redundant work and communication, and ineffective work fl ow were the main problems identi fi ed. Providers suggested initiating a patient database, modifying the electronic health records, and developing an institutional map for heart failure care. Outcome measures were studied among 100 patients (mean age ¼ 61.92 years, SD ¼ 15.75; mean left ventricular ejection fraction ¼ 31.15%, SD ¼ 7.89). The mean guideline adherence indicator increased signi fi cantly (p ¼ 0.007) from baseline (87.50 ± 22.14%) to follow-up (94.50 ± 15.54%). At follow-up, there was a signi fi cant reduction for risk of heart failure hospitalization (RR: 0.761, 95% CI: 0.652 to 0.889). Most study participants agreed that all MCM components could solve existing problems with heart failure care. Conclusion : The PAR strategy used to develop the MCM for this heart failure clinic with limited resources was feasible and led to quality-of-care improvements.