This study addresses, 'Self-Management Strategies Across Chronic Diseases' and Healthy People 2010goal 12-6 to reduce HF hospitalizations. Heart failure (HF) affects 5 million Americans, with costs estimatedat $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 clinicappointments/multidisciplinary discussion sessions and structured self-management with patient checklistdiaries, algorithms and telephone reinforcement. The intervention is based on American College ofCardiology national guidelines, emphasizing patient self-management (Bodenheimer, 2005) and theHealthcare Improvement Initiative for Idealized Clinical Practices. To assure all patients in the study havethe 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 compositeprimary endpoint of rehospitalization or death and secondary endpoints of health services use, costefficiency, 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 ofsymptom-reporting. This is a randomized clinical trial with 1treatment and 1 standard care (control) group.Each group will have 92 HF patients, total sample of n=184. Multivariate linear mixed model analyses will beused 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 ofcosts to other HF programs will be reported. The long-term goals are to improve HF self-management andtimely reporting of symptoms using safe and cost-efficient and practical interventions. The group clinicappointments with discussion sessions support and engage patients in self-management (checklistdiaries/symptom reporting algorithms), strengthen their HF home management and reduce overall re-hospitalization rates.
