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CPI 99-124 – HSR&D Study

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CPI 99-124
Trial of a Tailored Message Program to Implement CHF Guidelines
Terrence M. Shaneyfelt MPH MD
Birmingham VA Medical Center, Birmingham, AL
Birmingham, AL
Funding Period: April 2000 - March 2004

BACKGROUND/RATIONALE:
Congestive heart failure is a serious health problem in the United States and is associated with excessive morbidity and mortality. Several classes of medications have been shown to improve mortality in patients with CHF. Despite this these medications are widely under prescribed. Guidelines have been shown to improve patient outcomes and several guidelines on the management of CHF have been published. Implementation of guidelines is challenging and most strategies have focused on changing physician behavior. Patient-based interventions have been shown to be effective in implementing guidelines on CHF but they have been very labor intensive. A computer based intervention to implement CHF guidelines, if effective, would be beneficial.

OBJECTIVE(S):
Patients with CHF consume a significant proportion of healthcare resources, with exacerbations of CHF being the second most common reason for medical admission to VA medical centers. Therefore, the main objective is to understand the impact of a tailored education message program designed for direct use by patients on medical resource use. Other objectives include understanding the tools impact on patient compliance and quality of life.

METHODS:
Patients have been randomized to one of two groups: 1) intervention group or the 2) control group. The intervention group receives the tailored education messages program. This program assesses patients’ beliefs about compliance with medications, diet, and self-monitoring. Based on identified barriers to compliance, intervention patients receive a tailored educational message to dispel these beliefs and improve compliance. The control group interacts with a generic healthcare website. Patients in both groups are monitored for hospitalization; emergent care visits, compliance with prescribed treatment and quality of life

FINDINGS/RESULTS:
106 subjects have been enrolled and randomized. Follow-up is completed and the data is being analyzed.

IMPACT:
This study is the first randomized study to evaluate a computerized guideline intervention strategy focused on patients with CHF instead of healthcare providers. If effective, this guideline implementation methodology could be adapted to the management of other chronic medical conditions.

PUBLICATIONS:
None at this time.


DRA: Health Systems
DRE: Technology Development and Assessment
Keywords: Behavior (patient), Chronic heart failure, Clinical practice guidelines
MeSH Terms: none

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