Congestive heart failure (CHF) outcomes depend critically on patients'effective self-management of their condition. Yet, patients with CHF are often frail, indigent, and socially isolated, factors that limit their ability to manage their self-care and access clinic-based services, leading to preventable hospitalizations and poor outcomes. This randomized trial will evaluate a six-month intervention that consists of group visits with CHF nurse managers in conjunction with a low-cost interactive voice response (IVR) telephone exchange system that promotes peer-to-peer communication and facilitates communication with care managers. The intervention is based on research on the positive impact of group visits and peer support on chronic disease outcomes and self-care behaviors, our own studies showing the effectiveness of IVR-based self-management supports, and a successful pilot study.
The Specific Aims are:1)To evaluate the effect of group visits + IVR-facilitated peer support on CHF patients'health-related quality of life, survival, and rates of hospital readmission;2) To assess the impact of the intervention on patients'self-management behaviors, use of guideline-concordant medications, perceived social support, depressive symptoms, and satisfaction with care;3) To identify the mediating factors influencing the intervention's effectiveness;and 4) To determine the incremental cost-effectiveness of the intervention. 408 moderate to high-risk CHF patients will be recruited in a community health care system serving large numbers of racial minority and socioeconomically vulnerable CHF patients. We will pair eligible patients based on gender and illness severity. Pairs will be randomized to either: 1) usual care;or 2) usual care in conjunction with the intervention. Participants in the intervention arm will receive brief training in Motivational Interviewing-based peer communication techniques and participate in an initial care manager- led interactive group visit. They will then be asked to communicate at least weekly with their partner using the IVR exchange. Pairs will be able to talk by phone but without divulging their home phone number, incurring the cost of long distance calls, or having primary responsibility to ensure that the peer contacts occur regularly. The IVR system also will support """"""""asynchronous"""""""" communication between peers using voicemail, as well as between participants and care managers. At months 3 and 6 of the intervention, participants will be invited to participate in group visits encouraging exchange and discussion on CHF self- management. Research staff will monitor the process via the Internet, and outcomes will be measured at six and 12-months. The intervention addresses multiple barriers to effective disease management common among CHF patients. If found effective, this approach could be used to improve health outcomes among patients with other chronic conditions, such as depression, chronic pain, or diabetes.
