{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T21:03:48Z","timestamp":1770325428653,"version":"3.49.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The Alberta Cardiac Access (ACA) initiative was implemented in the spring of 2008 to increase access to specialized heart failure (HF) clinics after hospital discharge.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We identified all adults hospitalized with a most responsible diagnosis of HF between April 1999 and December 2009. We randomly selected 1 episode of care per patient and evaluated outcomes using interrupted time series: the a priori specified primary outcome was all-cause readmission or death in the first 30 days postdischarge. Between 1999 and 2009, median length of stay increased from 8 days to 10 days (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), and 30-day mortality increased from 9.1% to 11.5% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) in the 37891 HF hospitalizations we examined. However, these temporal changes were attributable to the increasing comorbidity burden over time: the adjusted Risk Ratio for 30-day mortality in 2009 versus 1999 was 0.99, 95% confidence interval, 0.86 to 1.15. After adjusting for secular trends, the ACA initiative was associated with changes in 30-day postdischarge mortality or readmission rates (which were increasing 0.3% per month [0.2%\u20130.3%] pre-ACA and decreased 1.4% per month [0.3%\u20132.5%] in the 18 months post-ACA;\n              <jats:italic>P<\/jats:italic>\n              =0.008). After roll out of the ACA initiative, patients discharged from vanguard regions (those that had specialized HF clinics) exhibited lower 30-day postdischarge death\/readmission rates than those discharged from other areas of the province (18.6% versus 22.2%, adjusted odds ratio 0.83, 95% confidence interval, 0.75\u20130.93).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>An initiative which increased specialized HF clinic access was associated with a statistically significant improvement in 30-day postdischarge mortality\/readmission rates.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.112.971119","type":"journal-article","created":{"date-parts":[[2012,12,11]],"date-time":"2012-12-11T04:44:33Z","timestamp":1355201073000},"page":"76-82","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":31,"title":["Changes in Heart Failure Outcomes After a Province-Wide Change in Health Service Provision A Natural Experiment in Alberta, Canada"],"prefix":"10.1161","volume":"6","author":[{"given":"Finlay A.","family":"McAlister","sequence":"first","affiliation":[{"name":"From the Divisions of General Internal Medicine (F.A.M.) and Cardiology (J.A.B., P.K., D.J., J.E.), University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute (F.A.M., J.A.B., P.K., D.J., J.E.), Edmonton, Alberta, Canada; University of Calgary, Calgary, Alberta, Canada (H.Q.); and President and CEO, Alberta Center for Child, Family and Community Research, Edmonton, Alberta, Canada (R.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey A.","family":"Bakal","sequence":"additional","affiliation":[{"name":"From the Divisions of General Internal Medicine (F.A.M.) and Cardiology (J.A.B., P.K., D.J., J.E.), University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute (F.A.M., J.A.B., P.K., D.J., J.E.), Edmonton, Alberta, Canada; University of Calgary, Calgary, Alberta, Canada (H.Q.); and President and CEO, Alberta Center for Child, Family and Community Research, Edmonton, Alberta, Canada (R.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Padma","family":"Kaul","sequence":"additional","affiliation":[{"name":"From the Divisions of General Internal Medicine (F.A.M.) and Cardiology (J.A.B., P.K., D.J., J.E.), University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute (F.A.M., J.A.B., P.K., D.J., J.E.), Edmonton, Alberta, Canada; University of Calgary, Calgary, Alberta, Canada (H.Q.); and President and CEO, Alberta Center for Child, Family and Community Research, Edmonton, Alberta, Canada (R.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hude","family":"Quan","sequence":"additional","affiliation":[{"name":"From the Divisions of General Internal Medicine (F.A.M.) and Cardiology (J.A.B., P.K., D.J., J.E.), University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute (F.A.M., J.A.B., P.K., D.J., J.E.), Edmonton, Alberta, Canada; University of Calgary, Calgary, Alberta, Canada (H.Q.); and President and CEO, Alberta Center for Child, Family and Community Research, Edmonton, Alberta, Canada (R.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robyn","family":"Blackadar","sequence":"additional","affiliation":[{"name":"From the Divisions of General Internal Medicine (F.A.M.) and Cardiology (J.A.B., P.K., D.J., J.E.), University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute (F.A.M., J.A.B., P.K., D.J., J.E.), Edmonton, Alberta, Canada; University of Calgary, Calgary, Alberta, Canada (H.Q.); and President and CEO, Alberta Center for Child, Family and Community Research, Edmonton, Alberta, Canada (R.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Johnstone","sequence":"additional","affiliation":[{"name":"From the Divisions of General Internal Medicine (F.A.M.) and Cardiology (J.A.B., P.K., D.J., J.E.), University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute (F.A.M., J.A.B., P.K., D.J., J.E.), Edmonton, Alberta, Canada; University of Calgary, Calgary, Alberta, Canada (H.Q.); and President and CEO, Alberta Center for Child, Family and Community Research, Edmonton, Alberta, Canada (R.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Ezekowitz","sequence":"additional","affiliation":[{"name":"From the Divisions of General Internal Medicine (F.A.M.) and Cardiology (J.A.B., P.K., D.J., J.E.), University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute (F.A.M., J.A.B., P.K., D.J., J.E.), Edmonton, Alberta, Canada; University of Calgary, Calgary, Alberta, Canada (H.Q.); and President and CEO, Alberta Center for Child, Family and Community Research, Edmonton, Alberta, Canada (R.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.108.812172"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.748"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.959122"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.12.043"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1032017"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.05.055"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.109.877324"},{"key":"e_1_3_4_9_2","unstructured":"JCAHO performance measures accessed online at: http:\/\/www.jointcommission.org\/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx. 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