Congestive heart failure (CHF) is the leading cause of hospitalization for people 65 years of age or older. It is also associated with high rates of death and disability. African-American and other non-white populations are affected disproportionately. Prevalence, hospitalization, and death are all greater among non-whites compared with whites. In recent years, effective treatments have been demonstrated to convey substantial improvements in functioning and survival. Yet research documents that large numbers of patients do not receive recommended care, especially in minority communities. CHF patients have a key role to play in improving the effectiveness of management for this chronic condition. But patients often do not understand what the most important indicators of disease progression are, how to monitor them effectively, or how to intervene to prevent catastrophic decompensations. To supplement physicians' usual care, health plans and provider organizations are increasingly using nurses to facilitate patients' self-management and quality of care. The effectiveness of the nurse management strategy, however, has neither been rigorously evaluated under average conditions nor adapted to ethnically diverse, poor, urban communities. We propose to conduct a randomized controlled trial to evaluate the effectiveness of nurse management compared with usual care among CHF patients in East and Central Harlem in New York City. in paitnership with the communities' 6 major health providers, including municipal, private, and academic institutions, we will randomly assign 650 patients between nurse management and usual care. During the 12- month trial, nurse managers will use structured survey instruments to assess patients' needs, improve their drug therapy, and counsel them on specific aspects of knowledge, attitudes, and behaviors important to effective CHF management. We will assess differences between the 2 groups in hospitalization and functional status as primary outcomes and in satisfaction, costs, and cost-effectiveness as secondary outcomes. The study will provide new knowledge about the relationship between these outcomes and changes in specific patient knowledge, attitudes, and behaviors with respect to CHF management. In collaboration with quality improvement organizations, including the island Peer Review Organization of New York, we plan to disseminate any successful findings throughout the state.
| Hebert, Paul L; Sisk, Jane E; Wang, Jason J et al. (2008) Cost-effectiveness of nurse-led disease management for heart failure in an ethnically diverse urban community. Ann Intern Med 149:540-8 |
