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RRP 09-175 – HSR&D Study

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RRP 09-175
Heart Failure Outcomes: A Self-Management Care Coordination Pilot Program
Britta Neugaard PhD MPH BA
James A. Haley Veterans' Hospital, Tampa, FL
Tampa, FL
Funding Period: April 2010 - March 2011

BACKGROUND/RATIONALE:
There are 5.8 million people in the United States with heart failure (HF). It is the most common reason for hospitalization among Medicare patients, leading to high utilization of health care resources. Given the high cost of care for patients with HF, there is a pressing need in the VHA for new approaches to HF treatment. The approaches utilized in this study are disease management, transition home, and care coordination.

OBJECTIVE(S):
The purpose of this study was to assess differences in the self-management of HF among those given intensive education and care coordination compared to those given the standard HF education prior to discharge home.

METHODS:
This prospective, pilot study utilizing quantitative and qualitative methods, compared intensive education and care coordination (intervention) to usual care (control) for patients. admitted with a diagnosis of HF. Study subjects were assigned to intervention or control groups based on their inpatient unit. Patients in the intervened group received HF treatment following evidence-based care maps for HF, follow-up with primary care within 10 days of discharge, enhanced education packet with nutrition guidelines, weight log, refrigerator magnets to self- assess signs/symptoms of HF exacerbations, and referral to HF-specific outpatient clinics. Forty-eight hours after being discharged home patients were called to assess patterns of self-management. Questions covered the following topics: weight and blood pressure management, diet assessment, signs and symptoms of HF, social support, medication reconciliation and future primary care appointments. Of the 131 people approached about study participation, 57 were enrolled with 40 completing the discharge phone call (20 patients in each study group). Data were analyzed for significance using t-tests and Fisher's exact test for non-parametric data. In addition, focus groups were conducted among 6 patients in the intervened group, and 4 patients in the non-intervened group.

FINDINGS/RESULTS:
Responses from discharge phone-calls showed significant findings between intervention and control groups, with intervened patients more likely to weigh themselves every day (p-value = <0.0001, OR = 3.16, 95% CI =1.60, 6.22 ), have a scale at home (p-value = 0.004, OR = 1.73, 95% CI = 1.15, 2.6), record their weight (p-value = <0.0001, OR = 2.57, 95% CI = 1.39, 4.76) and practice a new or different health behavior (p-value = 0.029, OR = 1.61, 95%CI = 1.04, 2.50). Patients in both groups requested more information on exercise and how to combat fatigue and more assistance with meal planning. Those in the intervened group reported weighing themselves daily made them more aware of how their diet affects their weight and how they feel.

IMPACT:
Intensive care coordination received during the hospitalization was associated with improved self-management of HF.

PUBLICATIONS:
None at this time.


DRA: Aging, Older Veterans' Health and Care, Cardiovascular Disease
DRE: Prognosis, Treatment - Observational
Keywords: Patient-centered Care, QUERI Implementation, Self-care, Chronic heart failure
MeSH Terms: none

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