Transitional Care of Heart Failure Patients

Introduction

Heart failure has been described as the inability of the heart to pump adequate blood to meet body requirements. Heart failure causes a variety of symptoms including leg swelling, shortness of breath and intolerance to exercise. According to the American Heart Association, in the year 2007 251.2 per 100 000 people died due to heart failure which was a 27.8% decline compared to 1997. This clearly illustrates the fact that the death rates have declined but the burden of disease still remains high. According to the 2007 data over 2200 Americans die each day from heart failure or heart related complications. This translates to a death every 39 seconds. The causes of heart failure vary with different populations and with different ages. Some of the causes include hypertension, diabetes and diabetes. These associated conditions are responsible for the high rate of hospitalization of these patients.

Research Question

In a population of patients discharged from a Midwest community base hospital with primary diagnosis of Heart Failure, will the use of an individual follow up program reduce the 30 day readmission rate?

Research Problem Establishment

Heart Failure patients are high-risk chronically ill patients who contribute significantly to the 30 day readmission rate for hospitalizations. According to JAGS (2004), “Although reports of randomized, controlled trails (RCTs) have yielded important information regarding the management of adults hospitalized for Heart Failure, little is known about the effectiveness of care management strategies for elders experiencing an acute episode of Heart Failure complicated by multiple other chronic conditions.” There have been 2 extensive research trails by Coleman, and Naylor that have tested multidisciplinary, register nurse directed, home base interventions specifically targeting hospitalized older patients with Heart Failure and co-existing chronic conditions. “Both trails demonstrated only short-term reductions in Heart Failure re-hospitalizations and no effect on readmission due to comorbid conditions”, (Jags, 2004).

Causes of high utilization and cost were contributed to deviations from evidence-based care, poor communication among primary providers, specialists, health and community providers, and patients. In addition, the lack of longitudinal management - care geared primarily toward acute episodes rather than long term stability and lack of an alternative to hospital admission contributed to the increased numbers. Other causes included failure to identify change in patient condition early, failure to address patient’s individual psychosocial issues and ineffective transition management post hospitalization. (Boutwell, A., Hwu, S., 2009).

Research Objectives

ü  To effectively and efficiently manage the ever growing Heart Failure (HF) patient population.

ü  To ensure the development of an evidence-based Heart Failure Program managed by a Heart Failure Resource Center.

ü  To positively impact length of stay, 30-day readmissions, compliance with core measures, and co-ordinate an aligned approach utilizing time sensitive interventions, and follow-ups through a specific outpatient management plan.

Study Hypothesis

Strategically, significant reduction in 30-day readmission rates, by applying specific individual interventions, and follow-up via a Heart Failure Resource Center.

Methodology

Sampling Method and Study Design

The study design will be based on data collected for the pilot and control group, the average charge (reflective of costs), the average length of stay (LOS) and the thirty day readmission rate. The study will apply qualitative statistical methods. According to Silverman (2000), the methods will involve providing in-depth explanation to observed behaviours. A sample survey approach will be used. The approach involves selecting and studying a random and finite subset of a population (Bhattacharyya & Johnson 1977). Sample observations are then used to make conclusions about the entire population. In the method, all population units will have equal chances of being included in the sample and consequently, formation of an unbiased sample. Participants will be both male and female patients.

Because the research will involve studying the two sexes separately, it will adopt a stratified sampling design (Dorofeev & Grant 2006). A total of 100 individuals will participate in the study. Each stratum will have 50 individuals, where 30 patients will form a study group while 20 individuals will form a control group. Both primary and secondary data sources will be used in the study. Primary sources will encompass observations from practical procedures.

Data analysis

Both descriptive and inferential statistics will be used in analysis. Descriptive analysis will entail computation of means, variances and range of observed values (Holcomb, 1997). Inferential statistical analysis will involve determining significant meanings of statistics obtained in descriptive analysis (Miller 1997). That is, inferential procedures will involve using SPSS to analyze collected data. All continuous data will be expressed as mean ± Standard Deviation. Categorical data will, however, be expressed as real numbers (Wilcox 2010). For continuous variables, Shapiro-Wilk test will be used to test for normality of the distribution. One-way ANOVA and Chi-square test will be used to compare continuous and discrete variables respectively.

Conclusion

In my research I intend to identify effective ways to reduce the duration of time spent in hospital by heart failure. In addition, I aim to nip the problem in the bud and find efficient ways of avoiding hospitalization in the first place. This will in turn save resources for hospitals and for patients whose expenditure increases because of extended stay in hospital. In addition, the bed spaces that these patients occupy could be used by others in need of attention. Research suggests, “ that a multidimensional, individual approach targeting patients, and their care-givers, and emphasizing needs associated with the acute Heart Failure event, and coexisting conditions is the most clinically relevant, and potentially effective intervention,” (JAGS, 2004).