{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:25:05Z","timestamp":1753889105752,"version":"3.41.2"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:p>Quality improvement (QI) initiatives have become an integral part of patient-centered care. In this primer, we outline 6 steps for initiating, implementing, and monitoring improvement in heart failure care. These steps include acknowledging that improvement is needed and setting a culture for improvement; forming a QI team; understanding the local problem; generating improvement strategies that will fit with the local problem; monitoring; testing; and refining improvements, analysis of data, and interpretation of run charts. This primer provides tools and resources for clinicians who want to learn how to perform QI specifically in the field of heart failure. We will illustrate the application of these steps using a hypothetical example for a congestive heart failure postdischarge clinic.<\/jats:p>","DOI":"10.1161\/circheartfailure.116.003722","type":"journal-article","created":{"date-parts":[[2017,5,11]],"date-time":"2017-05-11T13:49:40Z","timestamp":1494510580000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Closing the Care Gap"],"prefix":"10.1161","volume":"10","author":[{"given":"Yasbanoo","family":"Moayedi","sequence":"first","affiliation":[{"name":"From the Department of Medicine (Y.M., T.S., E.E., S.A.S., J.K., R.M., C.B., H.J.R.), Division of Cardiology (Y.M., T.S., J.K., M.L., H.J.R.), and Centre for Quality Improvement and Patient Safety (E.E., R.M., C.B.), University of Toronto, Canada; Division of Nephrology, St-Michael\u2019s Hospital, Toronto, Canada (S.A.S., R.M.); Division of Nephrology, Stanford University, Palo Alto, CA (S.A.S.); and Ted Rogers Centre for Heart Research, Toronto, Canada (H.J.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toni","family":"Schofield","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (Y.M., T.S., E.E., S.A.S., J.K., R.M., C.B., H.J.R.), Division of Cardiology (Y.M., T.S., J.K., M.L., H.J.R.), and Centre for Quality Improvement and Patient Safety (E.E., R.M., C.B.), University of Toronto, Canada; Division of Nephrology, St-Michael\u2019s Hospital, Toronto, Canada (S.A.S., R.M.); Division of Nephrology, Stanford University, Palo Alto, CA (S.A.S.); and Ted Rogers Centre for Heart Research, Toronto, Canada (H.J.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward","family":"Etchells","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (Y.M., T.S., E.E., S.A.S., J.K., R.M., C.B., H.J.R.), Division of Cardiology (Y.M., T.S., J.K., M.L., H.J.R.), and Centre for Quality Improvement and Patient Safety (E.E., R.M., C.B.), University of Toronto, Canada; Division of Nephrology, St-Michael\u2019s Hospital, Toronto, Canada (S.A.S., R.M.); Division of Nephrology, Stanford University, Palo Alto, CA (S.A.S.); and Ted Rogers Centre for Heart Research, Toronto, Canada (H.J.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel A.","family":"Silver","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (Y.M., T.S., E.E., S.A.S., J.K., R.M., C.B., H.J.R.), Division of Cardiology (Y.M., T.S., J.K., M.L., H.J.R.), and Centre for Quality Improvement and Patient Safety (E.E., R.M., C.B.), University of Toronto, Canada; Division of Nephrology, St-Michael\u2019s Hospital, Toronto, Canada (S.A.S., R.M.); Division of Nephrology, Stanford University, Palo Alto, CA (S.A.S.); and Ted Rogers Centre for Heart Research, Toronto, Canada (H.J.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Kobulnik","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (Y.M., T.S., E.E., S.A.S., J.K., R.M., C.B., H.J.R.), Division of Cardiology (Y.M., T.S., J.K., M.L., H.J.R.), and Centre for Quality Improvement and Patient Safety (E.E., R.M., C.B.), University of Toronto, Canada; Division of Nephrology, St-Michael\u2019s Hospital, Toronto, Canada (S.A.S., R.M.); Division of Nephrology, Stanford University, Palo Alto, CA (S.A.S.); and Ted Rogers Centre for Heart Research, Toronto, Canada (H.J.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rory","family":"McQuillan","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (Y.M., T.S., E.E., S.A.S., J.K., R.M., C.B., H.J.R.), Division of Cardiology (Y.M., T.S., J.K., M.L., H.J.R.), and Centre for Quality Improvement and Patient Safety (E.E., R.M., C.B.), University of Toronto, Canada; Division of Nephrology, St-Michael\u2019s Hospital, Toronto, Canada (S.A.S., R.M.); Division of Nephrology, Stanford University, Palo Alto, CA (S.A.S.); and Ted Rogers Centre for Heart Research, Toronto, Canada (H.J.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chaim","family":"Bell","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (Y.M., T.S., E.E., S.A.S., J.K., R.M., C.B., H.J.R.), Division of Cardiology (Y.M., T.S., J.K., M.L., H.J.R.), and Centre for Quality Improvement and Patient Safety (E.E., R.M., C.B.), University of Toronto, Canada; Division of Nephrology, St-Michael\u2019s Hospital, Toronto, Canada (S.A.S., R.M.); Division of Nephrology, Stanford University, Palo Alto, CA (S.A.S.); and Ted Rogers Centre for Heart Research, Toronto, Canada (H.J.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meredith","family":"Linghorne","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (Y.M., T.S., E.E., S.A.S., J.K., R.M., C.B., H.J.R.), Division of Cardiology (Y.M., T.S., J.K., M.L., H.J.R.), and Centre for Quality Improvement and Patient Safety (E.E., R.M., C.B.), University of Toronto, Canada; Division of Nephrology, St-Michael\u2019s Hospital, Toronto, Canada (S.A.S., R.M.); Division of Nephrology, Stanford University, Palo Alto, CA (S.A.S.); and Ted Rogers Centre for Heart Research, Toronto, Canada (H.J.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather J.","family":"Ross","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (Y.M., T.S., E.E., S.A.S., J.K., R.M., C.B., H.J.R.), Division of Cardiology (Y.M., T.S., J.K., M.L., H.J.R.), and Centre for Quality Improvement and Patient Safety (E.E., R.M., C.B.), University of Toronto, Canada; Division of Nephrology, St-Michael\u2019s Hospital, Toronto, Canada (S.A.S., R.M.); Division of Nephrology, Stanford University, Palo Alto, CA (S.A.S.); and Ted Rogers Centre for Heart Research, Toronto, Canada (H.J.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.002594"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.11.013"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-2862-5"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.125435"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.09.038"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2011.01773.x"},{"key":"e_1_3_3_8_2","first-page":"345","article-title":"Adverse events among medical patients after discharge from hospital.","volume":"170","author":"Forster AJ","year":"2004","unstructured":"Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, Khan A, van Walraven C. 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