Article

Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial

Gerontological Nursing Science Center, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 05/2004; 52(5):675-84. DOI: 10.1111/j.1532-5415.2004.52202.x
Source: PubMed

ABSTRACT

To examine the effectiveness of a transitional care intervention delivered by advanced practice nurses (APNs) to elders hospitalized with heart failure.
Randomized, controlled trial with follow-up through 52 weeks postindex hospital discharge.
Six Philadelphia academic and community hospitals.
Two hundred thirty-nine eligible patients were aged 65 and older and hospitalized with heart failure.
A 3-month APN-directed discharge planning and home follow-up protocol.
Time to first rehospitalization or death, number of rehospitalizations, quality of life, functional status, costs, and satisfaction with care.
Mean age of patients (control n=121; intervention n=118) enrolled was 76; 43% were male, and 36% were African American. Time to first readmission or death was longer in intervention patients (log rank chi(2)=5.0, P=.026; Cox regression incidence density ratio=1.65, 95% confidence interval=1.13-2.40). At 52 weeks, intervention group patients had fewer readmissions (104 vs 162, P=.047) and lower mean total costs ($7,636 vs $12,481, P=.002). For intervention patients, only short-term improvements were demonstrated in overall quality of life (12 weeks, P<.05), physical dimension of quality of life (2 weeks, P<.01; 12 weeks, P<.05) and patient satisfaction (assessed at 2 and 6 weeks, P<.001).
A comprehensive transitional care intervention for elders hospitalized with heart failure increased the length of time between hospital discharge and readmission or death, reduced total number of rehospitalizations, and decreased healthcare costs, thus demonstrating great promise for improving clinical and economic outcomes.

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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
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    • "satisfaction comparable to primary care physicians across a variety of settings and diagnoses (Mundinger et al. 2000; Venning et al. 2000; Brooten et al. 2002; Sakr et al. 2003; Lenz et al. 2004; Naylor et al. 2004; Wilson et al. 2005; Sears et al. 2007b; Ohman-Strickland et al. 2008). "
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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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