Article

Randomized Controlled Trial of Telephone Case Management in Hispanics of Mexican Origin With Heart Failure

School of Nursing and Leonard Davis Institute, University of Pennsylvania, Philadelphia, 19104-6096, USA.
Journal of cardiac failure (Impact Factor: 3.07). 05/2006; 12(3):211-9. DOI: 10.1016/j.cardfail.2006.01.005
Source: PubMed

ABSTRACT Disease management is effective in the general population, but it has not been tested prospectively in a sample of solely Hispanics with heart failure (HF). We tested the effectiveness of telephone case management in decreasing hospitalizations and improving health-related quality of life (HRQL) and depression in Hispanics of Mexican origin with HF.
Hospitalized Hispanics with chronic HF (n = 134) were enrolled and randomized to intervention (n = 69) or usual care (n = 65). The sample was elderly (72 +/- 11 years), New York Heart Association class III/IV (81.3%), and poorly educated (78.4% less than high school education). Most (55%) were unacculturated into US society. Bilingual/bicultural Mexican-American registered nurses provided 6 months of standardized telephone case management. Data on hospitalizations were collected from automated systems at 1, 3, and 6 months after the index hospital discharge. Health-related quality of life and depression were measured by self-report at enrollment, 3, and 6 months. Intention to treat analysis was used. No significant group differences were found in HF hospitalizations, the primary outcome variable (usual care: 0.49 +/- 0.81 [CI 0.25-0.73]; intervention: 0.55 +/- 1.1 [CI 0.32-0.78] at 6 months). No significant group differences were found in HF readmission rate, HF days in the hospital, HF cost of care, all-cause hospitalizations or cost, mortality, HRQL, or depression.
These results have important implications because of the current widespread enthusiasm for disease management. Although disease management is effective in the mainstream HF patient population, in Hispanics this ill, elderly, and poorly educated, a different approach may be needed.

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    • "To reduce costly re-admissions and to improve health outcomes, a multidisciplinary approach has been incorporated into a range of heart failure (HF) management programs [3]. These can be delivered in-person (predominantly via specialist clinics [4] [5] [6] [7] [8] or outreach, home visits) [9] [10] [11] [12] [13] [14] [15] or remotely (e.g. via structured telephone support) [16] [17] [18] [19] [20] [21] [22]. Although a recent systematic review and meta-analysis [23] found that home-visiting programs and multidisciplinary HF clinic interventions reduced all-cause readmissions and mortality, prior to the " WHICH? "
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    ABSTRACT: Objective: To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics. Methods: A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost–utility ratios were computed based on quality adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB. Results: During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+0.26 years per person; p = 0.078) and lower total healthcare costs (AU$ −13,100 per person; p = 0.025) mainly driven by significantly reduced duration of all-cause hospital stay (−10 days; p=0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions <1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia. Conclusions: Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity. http://www.sciencedirect.com/science/article/pii/S0167527315302874
    International Journal of Cardiology 12/2015; 201:368–37. · 6.18 Impact Factor
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    • "To reduce costly re-admissions and to improve health outcomes, a multidisciplinary approach has been incorporated into a range of heart failure (HF) management programs [3]. These can be delivered in-person (predominantly via specialist clinics [4] [5] [6] [7] [8] or outreach, home visits) [9] [10] [11] [12] [13] [14] [15] or remotely (e.g. via structured telephone support) [16] [17] [18] [19] [20] [21] [22]. Although a recent systematic review and meta-analysis [23] found that home-visiting programs and multidisciplinary HF clinic interventions reduced all-cause readmissions and mortality, prior to the " WHICH? "
  • Source
    • "To reduce costly re-admissions and to improve health outcomes, a multidisciplinary approach has been incorporated into a range of heart failure (HF) management programs [3]. These can be delivered in-person (predominantly via specialist clinics [4] [5] [6] [7] [8] or outreach, home visits) [9] [10] [11] [12] [13] [14] [15] or remotely (e.g. via structured telephone support) [16] [17] [18] [19] [20] [21] [22]. Although a recent systematic review and meta-analysis [23] found that home-visiting programs and multidisciplinary HF clinic interventions reduced all-cause readmissions and mortality, prior to the " WHICH? "
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics. A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB. During median follow-up of 3.2years, HBI was associated with slightly higher QALYs (+0.26years per person; p=0.078) and lower total healthcare costs (AU$ -13,100 per person; p=0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10days; p=0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions <1year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia. Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 08/2015; 201:368–375. DOI:10.1016/j.ijcard.2015.08.066 · 6.18 Impact Factor
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