A Randomized Intervention to Improve Heart Failure Outcomes in Community-Based Home Health Care

Abstract

This study examines the effects of a home health intervention designed to standardize nursing care, strengthen nurses' support for patient self-management and yield better CHF patient outcomes. Participants were 371 Medicare CHF patients served by 205 nurses randomized to intervention and control groups in a large urban home healthcare agency (HHA). The intervention consisted of an evidence-based nursing protocol, patient self-care guide, and training to improve nurses'teaching and support skills. Outcome measures included home care,physician and emergency department (ED) use, hospital admission, condition-specific quality of life (QoL), satisfaction with home care services and survival at 90 days. The intervention was associated with a marginally significant reduction in the volume of skilled nursing visits (p = .074), and a reduction variation in the typical number of visits provided (p < .05), without a significant increase in physician or ED use or patient mortality. Hypothesized improvement in other outcomes did not occur.

Examining the use of facilitation within guideline dissemination and implementation studies in nursing

“…34,39 Some authors provided more detailed information than others regarding how implementation interventions were delivered, which made it challenging to determine what exactly was done. Facilitation activities varied in content, complexity, frequency, intensity, and duration (see Fig.…”

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

“…Strategies used in these initiatives have included passive dissemination of educational information to health care providers and patients, computerized order sets, automatically generated suggestions for care interventions, automated reminders attached to echocardiography results, as well as intensive education, direct feedback and care support from expert clinicians (161)(162)(163)(164)(165)(166)(167)(168)(169)(170)(171). Strategies that rely on passive dissemination of information to health care providers are, at best, modestly effective (162,167,168).…”

Quality of life assessment in heart failure interventions: a 10-year (1996–2005) review

“…Non significant trend towards more improvement with usual care. Generic QoL improved with usual care and worsened with intervention De Lusignan et al [157] To assess the effect of home telemonitoring Feldman et al [143] To assess the effect of a home health intervention designed to standardize nursing care, strengthen nurses' support for patient self-management and yield better CHF patient outcomes. 371 NS Evidence-based nursing protocol, patient self-care guide and training to improve nurses' teaching and support skills or control 13 MLHF No significant differences in QoL…”

“…Nine of the interventions reported no significant QoL effect [27,60,65,77,130,143,157,160,176]. Ojeda and colleagues [126] completed a 12-month follow-up of a study reporting beneficial effects of a discharge intervention and found that the benefits were not present at followup.…”