Multiple aspects of the Affordable Care Act of 2010 focus on reducing 30-day all-cause hospital readmission rates among heart failure patients, and African American men with heart failure may be among those at highest risk for rehospitalization following discharge. Chronic disease management programs are among the many tools used to improve heart failure self-care as well as reduce readmission rates. However, most chronic disease management programs are staffed by health care professionals limiting the generalizability of this model in some resource-poor communities. Therefore, laypersons, such as patient navigators, may be a viable alternative for the delivery of heart failure self-care education and the provision of emotional and instrumental support for heart failure self-care. In minority cancer populations, patient navigators have been effective in improving diagnostic and treatment outcomes by educating patients and assisting them with barriers to care. Patient navigators may be well-suited to perform comparable tasks, among African American men with heart failure, to address their unique barriers to self-care, including low heart failure symptom recognition and more frequent treatment-seeking delays. The use of laypersons trained as patient navigators may lead to health care solutions for high heart failure readmission rates, but the cost-effectiveness of such an approach is largely unknown. Therefore, in the Patient NAVIgation to Reduce Readmissions among Black Men with Heart Failure (NAVI-HF) study, we propose to recruit 416 African American men with heart failure receiving inpatient care at UAB Hospital and randomize them either to HF self-care education plus a patient navigator-delivered self-care plan (Patient Navigation + Education arm) after discharge or to HF self-care education alone (Educational Control arm). We will compare participant outcomes such as 30-day all-cause readmission rates, heart failure selfcare adherence as well as cost-effectiveness across the two intervention arms.
Our Specific Aims are: 1) To assess the 30-day all-cause readmission rates among male African Amencan HF patients receiving HF self-care education plus a patient navigator-delivered self-care plan versus heart failure self-care education alone 2) To assess the heart failure self-efficacy and heart failure self-care adherence among male African American HF patients receiving heart failure self-care education plus a patient navigator-delivered self-care plan versus heart failure self-care education alone 3) To evaluate the cost-effectiveness of heart failure self-care education plus a patient navigator-delivered self-care plan versus heart failure self-care education alone
African American men with heart failure are at a higher risk compared to other race gender groups for hospital readmission following a hospitalization. To reduce readmission rates among African American men with heart failure, the traditional chronic disease management approach to patient education should be tailored to address such a high risk population. Unique barriers to self-care among African American men may warrant the use of laypersons, such as patient navigators, in chronic disease management to deliver specialized heart failure self-care education and support to address health disparities in readmission rates.
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