first explored challenges providers faced when trying to provide quality CHF care. These included (1) Poor coordination of care. Patients saw primary care physicians, cardiologists, surgeons, dieticians, social workers, and others, who often failed to communicate with each other, and only the patient was aware of all the appointments and tests. (2) No access to outpatient or primary care. Patients were unsure of whom to reach out to with questions or concerns, and did not always have access to providers at the exact time they required care. This fragmentation almost always resulted in unnecessary emergency room or hospital visits. (3) Inadequate disease information and guidelines. At the time, there was very little information about CHF disease management. Neither professional organizations nor trade groups had issued CHF treatment guidelines.
To address these challenges, Duke began a program of care improvement, with three major CHF initiatives that evolved over the next 15 years, including the Duke Heart Failure Program, the Heart@Home Initiative, and Same Day Access Clinic.