A Health Equity Workflow for Timely Transcatheter Aortic Valve Replacement: Making Barriers Visible.

BACKGROUND

Severe aortic stenosis is associated with morbidity and mortality when untreated, making timely valve intervention essential. Transportation, financial, dental, caregiver, and care coordination barriers may delay progression through transcatheter aortic valve replacement (TAVR) evaluation.

PROJECT RATIONALE: Lake Charles Memorial Hospital identified missed appointments, variable referral progression, and inconsistent recognition of social determinants of health (SDOH) barriers during TAVR evaluation.

PROJECT SUMMARY: Beginning in 2023, transportation, dental, financial, and community resource pathways were expanded. A structural heart-specific Epic workflow later incorporated referral intake screening, SDOH screening, dental SmartPhrases, electronic resource connection, referral escalation, and dashboard monitoring. Across the cumulative phased workflow redesign, missed or rescheduled visits decreased from 31% to 3%, and referral-to-treatment interval improved from 43 to 20 days. During the pilot from 2025 Q4 to 2026 Q1, Epic SDOH screening completion reached 100%.

TAKE-HOME MESSAGE: Referral intake and SDOH screening can identify barriers and connect patients to resources supporting timely valve intervention.