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BACKGROUND/RATIONALE:
Heart failure (HF) care exemplifies efforts to improve chronic care over the past decade. Two of the most promising approaches, disease management and the Chronic Care Model, have evidenced success with heart failure patients but have not fully explored patients' engagement or activation in their own care.
OBJECTIVE(S):
The objective of this study is to determine the efficacy of a patient activation intervention (called Heart PACT Program) compared to usual care on activation, self-care management, and hospitalizations and emergency department (ED) visits in HF patients at high risk for hospital readmission. The investigators hypothesize that participants in the Heart PACT Program, as compared to usual care, will demonstrate improved activation, better self-care management, and fewer readmissions and ED visits.
METHODS:
This study is a 3-year, randomized, 2-group, repeated-measures design. Following eligibility screening and consent, 80 patients will be stratified by activation level and randomly assigned to usual care (n = 40), or the activation intervention/Heart PACT Program (n = 40). The primary outcome variables are patient activation using the Patient Activation Measure (PAM) (Hibbard et al., 2005), self-care using the Self-Care for Heart Failure Index (SCHFI) (Riegel et al., 2004), and resource use (hospital readmissions and ED visits) collected from VHA Medical SAS Inpatient and Outpatient Datasets. Outcomes will be measured at baseline, 3 months and 6 months. Resource use will be tracked for 1 year before and after enrollment. The intervention consists of 4 individual meetings/clinic appointments and phone call follow-up over 6 months. At the first individual meeting, the intervention leaders assess the patient's level of activation: stage 1 or 2 (low activation), stage 3 (medium), or stage 4 (high) based on the patient's PAM score and a brief interview. The intervention leaders then collaborate with patients to improve activation and self-management of heart failure: adhering to medications; monitoring weight, blood pressure, and symptoms; and implementing health behavior goals, e.g., weight, diet or activity changes. The primary analysis will be a randomized 2 (group: control vs. intervention) x 3 (time) repeated measures analysis of variance.
FINDINGS/RESULTS:
Recruitment and enrollment are in progress. Forty-four patients have completed baseline measures and been randomized.
IMPACT:
The potential impact would be a new delivery system based on patient activation for chronic illness management both within and outside the VA. Patient self-care competence would be improved leading to better patient-provider communication and healthcare resource use.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Treatment
Keywords:
Chronic heart failure, Education (patient), Nursing
MeSH Terms:
none
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