October 23, 2017 — University of North Carolina (UNC) School of Medicine cardiologist Anil Gehi, M.D., will use a $1.7 million grant from the Bristol-Myers Squibb Foundation to further innovate a care model that reduced hospitalizations for atrial fibrillation (Afib) patients presenting in the emergency room by more than 30 percentage points in its first year.
Atrial fibrillation, which affects more than 2.7 million Americans, is characterized by an irregular heartbeat and is associated with an increased risk for blood clots, stroke, heart failure and multiple other heart complications according to Gehi, who serves as associate professor of medicine at the UNC School of Medicine, program director of UNC’s Clinical Cardiac Electrophysiology Fellowship.
The three-year grant from the Bristol-Myers Squibb Foundation will enable Gehi to continue development of a new protocol he established at UNC Medical Center in 2015 through a pilot grant from the UNC Center for Health Innovation and adapt and evaluate its application primary care and urgent care settings as well.
“When we launched the pilot in 2015, we realized that many Afib patients were hospitalized unnecessarily, which certainly drives up the cost of healthcare for patients, and these hospitalizations didn’t necessarily improve quality of care,” Gehi said. “We felt that one of the major problems with Afib care was that it is very disorganized. Patients bounce around between many different providers – primary care providers, cardiologists, electrophysiologists, emergency medicine physicians. There’s just not very good coordination of care for these patients.”
As a result, there is very little emphasis on education and prevention, which is critical in managing a chronic condition like Afib, Gehi explained.
“I always tell my patients: I may never be able to cure you of your atrial fibrillation, but I can work with you to manage it so that it doesn’t affect your life,” Gehi said. “We teach patients the importance of stroke prevention. We teach them how to tell when they’re in atrial fibrillation, and we teach them what they can do themselves – when they need to seek medical attention and when they can manage it on their own. It’s about getting patients more engaged in their own health.”
For many Afib patients – particularly those in vulnerable populations – access to specialty care can be extremely limited. Gehi hopes this grant can improve and perhaps remedy the lack of access in areas in and around the Triangle, Rocky Mount and High Point through partnerships with UNC Hospitals Hillsborough campus, UNC Rex Healthcare, Nash Health Care and High Point Regional Hospital.
“We’re trying to address the problem of poor access by setting up a new pathway for care for patients who have the most challenging and urgent medical needs, primarily those who are coming into the emergency room,” Gehi said. “We have set up a new pathway here at UNC Medical Center by developing a new protocol for the emergency room so that ER physicians can triage Afib patients. Those patients who aren’t particularly high-risk for poor outcomes might be discharged from the ER and sent to an Afib transition clinic.”
The Afib clinic at UNC is located at UNC Cardiology’s Meadowmont clinic in Chapel Hill. It is staffed by clinical pharmacists, though the protocol provides for any advanced practice provider to be able to staff the clinic.
“One of the things that’s so novel about our protocol is that our clinic is staffed with clinical pharmacists trained in the management of chronic illnesses, like diabetes or Afib,” Gehi said. “They are able to see these patients on a next-day basis and are able to do a lot of the patient education, which has been missing from traditional care models. They can also coordinate Afib care across all the patient’s providers.”
The 30 percentage-point reduction in hospitalizations in 2015 demonstrated that Afib can be treated in an outpatient setting for most patients, despite the statistic that upwards of 80 percent of Afib patients who go to the ER throughout the country are hospitalized, Gehi said.
“We were able to get that number down in the 50 percent range, and with further education we should be able to reduce it even further,” Gehi said. “We are quite certain we have improved the quality of care for these patients, as well.”
The Bristol-Myers Squibb Foundation grant will allow Gehi to expand this program throughout the UNC Health Care system, and potentially into other clinics and hospitals in North Carolina and across the country.
“The grant proposal was to establish other Afib clinics like the one we did here, targeting areas with a high proportion of vulnerable patients and to train local providers how to triage the patients and which ones would be appropriate to send to our clinics,” Gehi said. “Our hope is that with this type of expansion, we can show that this model is scalable, and we’ll have a larger number of patients to demonstrate outcomes in better patient care, reduced emergency room visits, and reduced hospitalizations.
“We want this to be something that can be integrated into what is already present at other hospitals and primary care and specialty care clinics. It’s beneficial to patients, beneficial to the ER, and it’s beneficial to the providers.”
For more information: www.unchealthcare.org
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