This study addresses, """"""""Self-Management Strategies Across Chronic Diseases"""""""" and Healthy People 2010 goal 12-6 to reduce HF hospitalizations. Heart failure (HF) affects 5 million Americans, with costs estimated at $28.8 billion annually. Yet, in 2004, only 31% of HF patients received even the basic JCAHO- recommended discharge education. Public Health can be approved by intensive HF discharge and post- hospital follow-up programs. Thus, a practical intervention was created that combines HF patient group clinic appointments/multidisciplinary discussion sessions and structured self-management with patient checklist diaries, algorithms and telephone reinforcement. The intervention is based on American College of Cardiology national guidelines, emphasizing patient self-management and the Healthcare Improvement Initiative for Idealized Clinical Practices. To assure all patients in the study have the equal and nationally recommended HF education each subject is provided with our HF videotape series (produced under SBIR 1R43AG).
The specific aims are to test effects of the intervention on the composite primary endpoint of rehospitalization or death and secondary endpoints of health services use, cost efficiency, patient health status and HF quality of life. Also measured are patient HF knowledge, self- management behavior, preparedness for home care, participation with professionals and timeliness of symptom-reporting. This is a randomized clinical trial with 1 treatment and 1 standard care (control) group. Each group will have 92 HF patients, total sample of n=184. Multivariate linear mixed model analyses will be used to test effects of the intervention over 12 months. Traditional cost analysis and innovative cost- efficiency Data Envelopment Analysis will be used to compare group intervention costs. Comparisons of costs to other HF programs will be reported. The long-term goals are to improve HF self-management and timely reporting of symptoms using safe and cost-efficient and practical interventions. The group clinic appointments with discussion sessions support and engage patients in self-management (checklist diaries/symptom reporting algorithms), strengthen their HF home management and reduce overall re- hospitalization rates.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL085397-05
Application #
7848908
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Cooper, Lawton S
Project Start
2006-09-01
Project End
2013-05-31
Budget Start
2010-06-01
Budget End
2013-05-31
Support Year
5
Fiscal Year
2010
Total Cost
$657,730
Indirect Cost
Name
University of Kansas
Department
Type
Schools of Nursing
DUNS #
016060860
City
Kansas City
State
KS
Country
United States
Zip Code
66160
Reeder, Katherine M; Ercole, Patrick M; Peek, Gina M et al. (2015) Symptom perceptions and self-care behaviors in patients who self-manage heart failure. J Cardiovasc Nurs 30:E1-7
Smith, Carol E; Piamjariyakul, Ubolrat; Dalton, Kathleen M et al. (2015) Nurse-Led Multidisciplinary Heart Failure Group Clinic Appointments: Methods, Materials, and Outcomes Used in the Clinical Trial. J Cardiovasc Nurs 30:S25-34
Piamjariyakul, Ubolrat; Yadrich, Donna Macan; Russell, Christy et al. (2014) Patients' annual income adequacy, insurance premiums and out-of-pocket expenses related to heart failure care. Heart Lung 43:469-75
Smith, Carol E; Piamjariyakul, Ubolrat; Wick, Jo A et al. (2014) Multidisciplinary group clinic appointments: the Self-Management and Care of Heart Failure (SMAC-HF) trial. Circ Heart Fail 7:888-94
Piamjariyakul, Ubolrat; Smith, Carol E; Russell, Christy et al. (2013) The feasibility of a telephone coaching program on heart failure home management for family caregivers. Heart Lung 42:32-9
Bowden, Kasey; Fitzgerald, Sharon A; Piamjariyakul, Ubolrat et al. (2011) Comparing patient and nurse specialist reports of causative factors of depression related to heart failure. Perspect Psychiatr Care 47:98-104