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Effect on Outcomes and Resource Utilization of a
Focused Home-Based Education Program for Elderly Heart
Failure Patients
Debra Moser, D.N.Sc.,
Principal Investigator;
Lynn
Doering, D.N.Sc. (UCLA) and
Philip
Binkley, M.D. (The Ohio State University),
Co-investigators
Funded by the National American Heart
Association
(2000-2003)
Abstract
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Heart failure (HF) is the most common discharge diagnosis
for patients over age 65 and constitutes the single largest
Medicare expenditure in the U.S. While a variety of
interventions to improve HF patient outcomes have been
tested, few have been subjected to randomized trials, many
are not applicable to most clinical settings, and none have
examined the unique contribution of patient education and
counseling to enhancing patient outcomes cost effectively in
the most vulnerable patients.
The purpose of the proposed
project is to determine outcomes of a focused home-based
patient education and counseling program for elderly HF
patients. Specific aims are to compare the following
variables in elderly HF patients who receive a focused
home-based education and counseling program and in patients
who receive usual medical and nursing care: patient outcomes
(functional status, magnitude of HF symptoms, perceived
control, psychosocial adjustment to illness, and quality of
life); health care resource utilization (rehospitalization
rate, length of hospital stay, number of emergency room
visits, and unscheduled physician office visits); and total
costs of care (cost of the intervention program,
hospitalization costs, and emergency room visit costs).
A prospective randomized,
controlled clinical trial will be conducted at two sites
where physicians routinely apply published heart failure
guidelines to manage pharmacologic therapy so that the
contribution of education and counseling to optimal
pharmacologic therapy can be determined. A total of
300 patients who are aged 65 or older, hospitalized with a
diagnosis of HF, with previous HF admissions, NYHA
classification II-IV, and discharged home without home
health services or follow-up at a specialty HF clinic will
be enrolled and randomized to either the intervention group
or usual care group. The intervention group will receive a
focused education and counseling program comprised of 11
home visits and phone calls over 25 weeks by specially
trained registered nurses with an emphasis on individualized
application of the prescribed pharmacologic regime,
compliance to diet, activity, and weight monitoring
recommendations, reinforcement and repetition of
instruction, and coaching and problem-solving. The usual
care group will receive traditional inpatient education.
Demographic data and patient outcomes (functional status,
magnitude of HF symptoms, perceived control, psychosocial
adjustment to illness, and quality of life) will be measured
prior to hospital discharge. Patient outcomes, resource
utilization variables, and costs of care will all be
measured at six months, and one year.
Results of this study will
provide needed information about the role of appropriate
education and counseling in the management of elderly HF
patients and about its impact on important outcomes and
resource utilization.
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