Self Care system for Heart Failure out of hospital patients

CUORE is a Heart Failure (HF) Disease Assessment System that makes use of innovative approaches, based on Information Technologies (IT) and portable monitoring devices, for the continuous assessment of HF progression and cardiovascular risk stratification. The system valuates the cardiac condition integrating patient data from different sources with special emphasis in the information obtained for ECG processing. Rather than just evaluate the cardiovascular status, the system also aims to motivate patients to have an active role in their health management and to improve their cardiac condition by promotion of an active lifestyle. In order to make the system usable the methodology adopted to create the final solution is iterative and it involves users in all stages. This paper presents the conceptualization of CUORE as a solution to self care for heart failure out of hospital patients

Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease. The TELBIL study

<p>Abstract</p> <p>Background</p> <p>Telemonitoring technology offers one of the most promising alternatives for the provision of health care services at the patient's home. The primary aim of this study is to evaluate the impact of a primary care-based telemonitoring intervention on the frequency of hospital admissions.</p> <p>Methods/design</p> <p>A primary care-based randomised controlled trial will be carried out to assess the impact of a telemonitoring intervention aimed at home care patients with heart failure (HF) and/or chronic lung disease (CLD). The results will be compared with those obtained with standard health care practice. The duration of the study will be of one year. Sixty patients will be recruited for the study. In-home patients, diagnosed with HF and/or CLD, aged 14 or above and with two or more hospital admissions in the previous year will be eligible.</p> <p>For the intervention group, telemonitoring will consist of daily patient self-measurements of respiratory-rate, heart-rate, blood pressure, oxygen saturation, weight and body temperature. Additionally, the patients will complete a qualitative symptom questionnaire daily using the telemonitoring system. Routine telephone contacts will be conducted every fortnight and additional telephone contacts will be carried out if the data received at the primary care centre are out of the established limits. The control group will receive usual care. The primary outcome measure is the number of hospital admissions due to any cause that occurred in a period of 12 months post-randomisation. The secondary outcome measures are: duration of hospital stay, hospital admissions due to HF or CLD, mortality rate, use of health care resources, quality of life, cost-effectiveness, compliance and patient and health care professional satisfaction with the new technology.</p> <p>Discussion</p> <p>The results of this study will shed some light on the effects of telemonitoring for the follow-up and management of chronic patients from a primary care setting. The study may contribute to enhance the understanding of alternative modes of health care provision for medically unstable elderly patients, who bear a high degree of physical and functional deterioration.</p> <p>Trial Registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN89041993">ISRCTN89041993</a></p

A Structured Telephonic Transition Program for Heart Failure Patients

HF is a fatal condition affecting more than 5 million Americans leading to frequent hospitalizations, poor quality of life and death. The annual cost to the healthcare system is approximately $38 billion, ranking HF as one of the costliest conditions to manage. Significant evidence exists that HF self-care management programs improve patient self-care and decrease HF-related readmissions. Current guidelines recommend health professionals provide comprehensive HF education focused on knowledge, skills of management, and self-care behaviors. The Iowa Model of Evidence Based Practice provided the foundation for the practice change. Structured telephonic support (STS) was based on Bandura’s Self- Efficacy behavior theory. Education was initiated prior to discharge followed by STS weekly for 6 weeks. The Minnesota Living with Heart Failure Questionnaire (MLHFQ), was administered prior to discharge and again at 30 days to measure quality of life score improvement. The practice change project included 5 participants. One participant dropped out for a planned surgical procedure. The remaining 4 participants completed the program without any HF 30-day readmissions. There was a 23% improvement in mean MLHFQ scores 30 days after the practice change. Evidence-based HF self-care transition programs have the potential to assist HF patients to successfully transition from hospital to home, demonstrating improved quality of life and reduction in readmissions. The advanced practice nurse possesses the knowledge base and skill set to meet the individual HF patient needs by incorporating education and self care. A successful practice change that is sustainable can yield significant financial implications for the healthcare system

Discharge from Hospital to Home: Implementation and Use of the AHRQ IDEAL CHF Discharge Planning and AHA CHF Discharge Checklist

Section I: Abstract Problem: Hospital readmission rates in the congestive heart failure (CHF) population is a quality concern. As excessive readmissions tend to indicate low quality of care, government and private healthcare payers are increasing their focus on 30-day readmission rates as a new quality measure for hospitals. Context: This was a quality improvement project for a telemetry unit at a medical center in the Central Valley of California. There are 56,551 members in the Central Valley enrolled in the healthcare provider system and 2,567 patients with a primary or secondary diagnosis of CHF. Within the healthcare system, CHF was identified as the third most-admitted diagnosis to the telemetry unit, with an average stay of 5.4 days. Interventions: A multifaceted, evidence-based model was implemented using several interventions: (1) TeamSTEPPS Pre-Training Knowledge Assessment survey to gauge nurse CHF knowledge, (2) Agency for Healthcare Research and Quality IDEAL discharge planning resource, and (3) American Heart Association CHF discharge checklist. Measures: The goal of the project was to reduce the 30-day readmission rates for recently discharged patients from a baseline of 14% to 10% by July 2021, with a focus on the discharge education given to the patients and their family members. Results: Initially, there was a high level of interest and engagement among the nurses in educating the CHF patients and gauging their readiness for discharge. As the project progressed, nurse engagement faltered, with nursing staff reporting burn-out and increased stress from multiple improvement projects being implemented simultaneously. Patient feedback concluded that the discharge education provided by the nursing staff was beneficial and increased their comfort being discharged home to self-care. Due to time constraints with the project deadlines, the patient readmission rates could not be accurately assessed; although, results are expected to improve with the continuation of the education introduced during the project. Conclusion: Staff education on the available resources to assist them with CHF discharge education may increase the readiness of CHF patients to discharge home and reduce the 30-day readmission rates in the CHF patients on the telemetry unit in the Central Valley of California. Keywords: congestive heart failure, readmission, education, best practices, discharge planning, self-managemen

Factors Associated With Poor Medication Adherence In Hypertensive Patients In Lusaka, Zambia

Objectives: To determine the prevalence of drug adherence and factors associated with poor adherence to antihypertensive treatment among adults seen in the department of medicine at UTH. To investigate patient related and health care system related factors associated with poor adherence to antihypertensive Drugs.Methods: 237 adult patients aged 18 and above with previous diagnosis of essential hypertension receiving out patient care in the University Teaching Hospital (UTH) were recruited from the first week of November to the second week of December 2010. Information was collected regarding health care system related factors and care giver related factors to patient non adherence using self report and modified Hill-Bone compliance scale.Results: The prevalence of adherence was 83% by self report and 70% using modified Hill-Bone scale. The mean age was 57.8 &#177; 12.0 SD. Patients on three antihypertensive drugs were less likely to be nonadherent (OR 0.21; 95% 95% CI 0.06-0.79) than patients taking only one drug. Majority (60%) of the patients were reviewed at least twice in the last 6 months at the time of the interview. 195 (83%) patients reported that drugs prescribed were not available at the hospital pharmacy, but 186 (79%) of these were able to purchase the drugs elsewhere. Patients counseled by the nurse were more likely to be adherent than those not counseled by the nurse (OR 2.7: 95% CI1.0-7.3). Those who were counseled for more than 5 minutes had three fold likelihood of less non-adherence as reported by both self report and modified Hill-Bone with OR 0.3: 95% CI 0.2-0.8 and 0.3: 95% CI 0.1-0.5, respectively. Multivariable analysis showed that; participants were more likely to be non-adherent by self-report if they had attained a primary level of education, had missed appointments due to lack of transport, or had experienced the side effect of dizziness. Patients with heart failure were more likely to be nonadherent based on the modified Hill-Bone score.Conclusion: The prevalence of adherence among hypertensive patients was found to be higher than anticipated. The factors associated with nonadherence included side effect of dizziness, missed appointment due to lack of transport, and living at a distance of more than 10 km from the hospital. Taking 3 BP drugs and receiving more than 5 minutes of counseling about how to take medications were both associated with decreased likelihood of non-adherence

Norman Regional Health System: A City-Owned Public Trust Dedicated to Improving Performance

Describes successful strategies for providing recommended treatment on process-of-care measures, including board and administration support, order sets, concurrent review, performance feedback, transparency, and engaging nurses. Outlines lessons learned

Heart Failure Anticoagulation Teach-Back Education and Readmissions

abstract: Heart failure affects millions of Americans each year. Treatment of advanced heart failure with reduced ejection fraction and left ventricular failure is sometimes treated with implantation of a left-ventricular assist device. While living with this life-sustaining machine, anticoagulation with Coumadin is necessary. Many of these patients are readmitted within 30-days of being discharged for pump clots, gastro-intestinal bleeds and even strokes. Patients are often discharged without adequate education on Coumadin management, which promotes inadequate self-care and medication non-adherence. In current practice, healthcare providers lecture information in a quick manner without the evaluation of patients’ comprehension. Research suggests implementing the teach-back method during education sessions to assess for comprehension of material to improve medication adherence. Healthcare providers should implement Coumadin teach-back education to heart failure patients with left-ventricular assist devices to improve quality of life, increase medication adherence and decrease 30-day hospital readmission rates

Intermountain Healthcare's McKay-Dee Hospital Center: Driving Down Readmissions by Caring for Patients the "Right Way"

Outlines the hospital's strategies for low readmission rates for heart failure and pneumonia, including standardization of care, interdisciplinary care coordination and discharge planning, and integration with community providers, and lessons learned

Carolinas Medical Center: Demonstrating High Quality in the Public Sector

Outlines safety and quality improvement strategies including electronic medical records, multi­disciplinary teams accountable to leadership, reporting of performance indicators; and redesigned care processes. Discusses physician buy-in and nurses' roles