scholarly journals Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 317 ◽  
Author(s):  
Lufei Young ◽  
Sue Barnason ◽  
Van Do
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Economic Burden ◽  
Rural Areas ◽  
Care Service ◽  
Hospital Readmissions ◽  
Patient Activation ◽  
Rural Hospitals ◽  
Self Management ◽  
Heart Failure Patients

Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients’ health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals.Objective This article describes the study design and research methods used to implement and evaluate the intervention.Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH]) to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only) to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months.DiscussionThis study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden. Clinical Trial Registration Information: ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053

scholarly journals Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol

F1000Research ◽  
2015 ◽  
Vol 3 ◽  
pp. 317 ◽  
Author(s):  
Lufei Young ◽  
Sue Barnason ◽  
Van Do
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Economic Burden ◽  
Rural Areas ◽  
Care Service ◽  
Hospital Readmissions ◽  
Patient Activation ◽  
Rural Hospitals ◽  
Self Management ◽  
Heart Failure Patients

Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients’ health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals.Objective This article describes the study design and research methods used to implement and evaluate the intervention.Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH]) to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only) to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months.DiscussionThis study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden. Clinical Trial Registration Information: ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053

scholarly journals Relationships between activation level, knowledge, self-efficacy, and self-management behavior in heart failure patients discharged from rural hospitals

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 150 ◽  
Author(s):  
Van Do ◽  
Lufei Young ◽  
Sue Barnason ◽  
Hoang Tran
Keyword(s):  
Heart Failure ◽  
Rural Areas ◽  
Self Efficacy ◽  
Hospital Readmissions ◽  
Patient Activation ◽  
Rural Hospitals ◽  
Self Management ◽  
Heart Failure Patients ◽  
Activation Level ◽  
Management Behaviors

Non-adherence to self-management guidelines accounted for 50% of hospital readmissions in heart failure patients. Evidence showed that patient activation affects self-management behaviors in populations living with chronic conditions. The purpose of this study was to describe patient activation level and its relationship with knowledge, self-efficacy and self-management behaviors in heart failure patients discharged from rural hospitals. Our study populations were recruited from two hospitals in rural areas of Nebraska. We found that two-thirds of the participants reported low activation levels (e.g., taking no action to manage their heart failure condition). In addition, low patient activation levels were associated with inadequate heart failure knowledge (p=.005), low self-efficacy (p<.001) and low engagement in heart failure self-management behaviors (p<.001) after discharge from hospital.

Abstract P76: Effect of Patient Activation on Self-Management Behaviors in Heart Failure

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Martha Shively ◽  
Nancy Gardetto ◽  
Mary Kodiath ◽  
Ann Kelly ◽  
Tom Smith
Keyword(s):  
Heart Failure ◽  
Usual Care ◽  
Repeated Measures ◽  
Intervention Group ◽  
Patient Activation ◽  
Self Care ◽  
Self Report ◽  
Self Management ◽  
Significant Group ◽  
Repeated Measures Design

Background Disease management and chronic care models have evidenced success with heart failure (HF) patients but have not fully explored patients' engagement/activation in self- care. Objective Determine efficacy of a patient activation intervention (Heart PACT Program) compared to usual care on activation and self-care management in HF. Methods This study was a 4-year, randomized, 2-group, repeated-measures design (baseline, 3 months, and 6 months). Following consent, 84 patients were stratified by activation level and randomly assigned to usual care (n = 41), or usual care plus the activation intervention (n = 43). The primary outcome variables were patient activation using the Patient Activation Measure (PAM) (Hibbard et al., 2005), and self-care using the Self-Care for Heart Failure Index (SCHFI) (Riegel et al., 2004) and the Medical Outcomes Study (MOS) Specific Adherence Scale. The intervention consisted of individual meetings and phone call follow-up over 6 months based on the patient's level of activation: stage 1 or 2 (low activation), stage 3 (medium), or stage 4 (high) as assessed by the patient's self-report PAM score and brief interview. The leaders collaborated with patients to improve activation and self-management of HF: adhering to medications; monitoring weight, blood pressure, and symptoms; and implementing health behavior goals. Findings Participants were primarily male (99%), Caucasian (77%), and classified as NYHA III (52%). The mean age was 66 years (SD 11). The majority (71%) of participants reported 3 or more comorbid conditions. The intervention group compared to the usual care group showed a significant increase in activation/PAM scores from baseline to 6 months (significant group by time interaction linear contrast, F=16.90, p=.02). Although the baseline MOS mean was lower in the intervention group, results revealed a significant group by time effect (F=9.16, p = .001) with the intervention group improving more over time. There were no significant group by time interactions for the SCHFI. Conclusion Patient activation can be improved through targeted intervention. The patient activation model has the potential to change approaches to tailored patient education for self-management in heart failure.

scholarly journals Increasing Self-Management Skills in Heart Failure Patients: A Pilot Study

2005 ◽  
Vol 11 (6) ◽  
pp. 297-302 ◽  
Author(s):  
Kristin J. Flynn ◽  
Lynda H. Powell ◽  
Carlos F. Mendes de Leon ◽  
Rocio Muñoz ◽  
Claudia B. Eaton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pilot Study ◽  
Self Management ◽  
Management Skills ◽  
Heart Failure Patients

Application of a Marketing Concept to Patient-Centered Care: Co-Producing Health With Heart Failure Patients

2012 ◽  
Vol 17 (2) ◽  
Author(s):  
Robert Leone ◽  
Charles Walker ◽  
Linda Curry ◽  
Elizabeth Agee
Keyword(s):  
Heart Failure ◽  
Hospital Readmissions ◽  
Patient Centered Care ◽  
Future Research ◽  
Marketing Concept ◽  
Patient Centered ◽  
Heart Failure Patients ◽  
Hospital Units ◽  
Effective Discharge ◽  
Centered Care

Increasing numbers of patients are being treated for heart failure each year. One out of four of the heart failure patients who receives care in a hospital is readmitted to the hospital within 30 days of discharge. Effective discharge instruction is critical to prevent these patient readmissions. Co-production is a marketing concept whereby the customer is a partner in the delivery of a good or service. For example, a patient and nurse may partner to co-produce a patient-centered health regimen to improve patient outcomes. In this article we review the cost of treating heart failure patients and current strategies to decrease hospital readmissions for these patients along with the role of the nurse and the concept of co-producing health as related to heart failure patients. Next we describe our study assessing the degree to which discharge processes were co-produced on two hospital units having a preponderance of heart failure patients, and present our findings indicating minimal evidence of co-production. A discussion of our findings, along with clinical implications of these findings, recommendations for change, and suggestions for future research are offered. We conclude that standardized discharge plans lead to a mindset of ‘one size fits all,’ a mindset inconsistent with the recent call for patient-centered care. We offer co-production as a patient-centered strategy for customizing discharge teaching and improving health outcomes for heart failure patients.

Sign in / Sign up

Export Citation Format

Share Document