The proposed project, """"""""Patient Decision Support and Coaching,"""""""" is a three-year and two month trial of a novel approach to improving the use of secondary prevention following hospitalization for myocardial infarction. The investigators previously developed and pilot tested a program that uses a brief patient decision- support booklet and nurse telephone counseling to """"""""coach"""""""" patients to begin and continue secondary prevention. The intervention, the Heart After-hospital Recovery Planner (HARP), engages the patient, HARP nurse and treating physician(s) in reviewing evidence about medical and behavioral secondary prevention strategies and developing a plan for the patient's recovery. Nurse counselors, based in the hospital, then make follow-up telephone calls at 1, 2, 4 weeks to help solve problems and reinforce decisions made using the HARP booklet. Nurses also """"""""coach"""""""" patients to ask questions at upcoming visits to both primary care and cardiology or cardiac surgeon physicians. The project will serve as a prototype of a combined """"""""decision support and coaching"""""""" intervention. The study is a two-community study, comparing intervention and control communities in Michigan. The study will enroll all English-speaking patients with confirmed myocardial infarction without renal failure who are well enough to be interviewed in-hospital and consent to participate.
The specific aims of the research are to: 1) Determine whether use of HARP leads to improved rates of post-MI physician medication prescribing compared with usual care; 2) Determine whether patients who participate in HARP improve medical and behavioral secondary prevention compared with controls at 3 months and 12 months following hospitalization; 3) Determine whether participation in HARP leads to improved health and well-being, compared with usual care; 4) Determine whether participation in HARP leads to improved perceived heart health competence and participation in decision-making, compared with usual care; 5) Evaluate the cost-utility of HARP compared to usual care. The importance of the HARP intervention lies in its potential to develop decision support and coaching interventions to improve the ability of the health care system to deliver the right care to the right patient, reliably, at the right time. Nationwide, both medical and behavioral secondary prevention is under- utilized. HARP builds on previous research in patient decision- support and telephone counseling to encourage implementation of secondary prevention strategies by patients and physicians. The intervention has been developed in community practice settings to intrude minimally into hospital and office routines. Should HARP prove successful post-MI, it can serve as a prototype delivery vehicle for other evidence-based interventions.
