Rehospitalizations among heart failure (HF) patients are common due to a HF trajectory marked by sudden, acute exacerbations of illness. Nearly 1/5 of HF patients with Medicare are rehospitalized within 30 days of discharge, contributing to United States (US) HF costs of nearly 40 billion dollars a year. With the aging of the baby boomer population, these costs will rapidly increase in the future. Recent Medicare reimbursement changes place heavy penalties for 30 day hospitalizations related to HF, adding to the increasing financial burden of HF on the health care system. Despite efforts to prevent unnecessary HF hospitalizations through increased HF education, medical support after discharge, and telehealth programs, rehospitalization rates remain high. Current hospitalization prediction models for HF use patient characteristics (e.g. age, race, comorbidities) that do not consistently or strongly predict readmission -suggesting the need to examine and explore other patient characteristics such as medical decision making. Decision making in HF patients prior to being rehospitalized is complex, multifaceted, and poorly understood. In 2012, the American Heart Association (AHA) scientific report on decision making in advanced HF, identified the critical need for clinicians to understand HF patient decision making to promote effective, timely, efficient, and safe patient-centered care. Additionally, it is unknown if decision making processes differ between HF patients who have been rehospitalized within and beyond 30 days. The main goal of the study is to compare: (1) HF self-care, (2) decisional delays, and (3) decisions prior to hospitalization between HF patients who are rehospitalized within and beyond 30 days. The study, guided by a modified naturalistic decision making framework, uses a convergent parallel mixed-methods design to gain an in-depth understanding of the HF patient's decision making process with a focus on the critical modifiable variables of self-care and decisional delay. HF patients will be asked to complete a survey and participate in an interview about their decision making prior to rehospitalization. The proposed study is directly aligned with the National Institute of Nursing Research's (NINR) strategic plan to develop strategies that assist patients in better managing their chronic illness.

Public Health Relevance

Decreasing rehospitalization rates is critical to reducing heart failure (HF) costs, which are projected to increase 120% by 2030. The study will examine the decisions made before rehospitalization from a HF patient perspective in order to gain a more comprehensive understanding of: (1) how patients manage their HF and when they decide to seek medical attention, and (2) whether or not decisions prior to rehospitalization differ between patients who are rehospitalized within and beyond 30 days of their last hospital admission for HF. Findings will be used to develop HF patient decision support aides to improve their management of HF, which may decrease unplanned rehospitalizations and health care costs.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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Johns Hopkins University
Other Health Professions
Schools of Nursing
United States
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