TY - JOUR
T1 - Effects of a home-based activation intervention on self-management adherence and readmission in rural heart failure patients
T2 - The PATCH randomized controlled trial
AU - Young, Lufei
AU - Hertzog, Melody
AU - Barnason, Susan
N1 - Funding Information:
As the principle investigator (PI) of the study, Dr. Young contributed the essence part of this manuscript from study’s conception and design; acquisition of data and preparation of the manuscript. Other authors contributed extensively to the work presented in this paper. Dr. Barnason, as co-PI, contributed to the development of conceptual framework, intervention protocol, outcomes and their instrument selection, manuscript revisions, as well as other essential part of manuscript preparation. Dr. Hertzog contributed in analysis and interpretation of data, manuscript preparation, and table and figure editing. This research was funded by National Institute of Health and National Institute of Nursing Research (NIH/NINR) through grant number 1R15NR 13769-01A1.
Funding Information:
Research reported in this publication was supported by the National Institutes Nursing Research of the National Institutes of Health under award number 1R15NR 13769-01A1. The sponsor had no role in conducting the study, preparing and disseminating the study results. The authors are the recipients of the funding provided by the National Institutes Nursing Research of the National Institutes of Health. She has full access to the study data and takes responsibility for their integrity and the accuracy of the data analysis.
Publisher Copyright:
© 2016 The Author(s).
PY - 2016/9/8
Y1 - 2016/9/8
N2 - Background: Heart failure (HF) patients discharged from rural hospitals have higher 30-day readmission rates. Self-management (SM) reduces readmissions, but adherence to SM guidelines is low in the rural HF population. We tested a home-based intervention to enhance patient activation and lead to improved SM adherence. Methods: In this two-group, repeated measures randomized control trial, the main outcomes were patient reported and clinical outcomes associated with SM adherence, and all-cause readmission at 30, 90 and 180 days. Results: The study included 100 HF patients discharged from a rural critical access hospital. The intervention group received a 12-week SM training and coaching program delivered by telephone and tailored on subjects' activation levels. At α=.10, the PATCH intervention showed significantly greater improvement compared to usual care in patient-reported SM adherence: weighing themselves, following a low-sodium diet, taking prescribed medication, and exercising daily (all p<.0005) at 3 and 6 months after discharge. In contrast, groups did not differ in physical activity assessed by actigraphy or in clinical biomarkers. Contrary to expectation, the 30-day readmission rate was significantly higher (p=.088) in the intervention group (19.6 %) than in the control group (6.1 %), with no differences at 90 or 180 days. Conclusion: It is feasible to conduct a randomized controlled trial in HF patients discharged from rural critical access hospitals. Significantly higher patient-reported SM adherence was not accompanied by lower clinical biomarkers or readmission rates. Further research is needed to understand mechanisms that influence outcomes and healthcare utilization in this population. Trial registration: Clinical Trial Registration Information: ClinicalTrials.gov; NCT01964053.
AB - Background: Heart failure (HF) patients discharged from rural hospitals have higher 30-day readmission rates. Self-management (SM) reduces readmissions, but adherence to SM guidelines is low in the rural HF population. We tested a home-based intervention to enhance patient activation and lead to improved SM adherence. Methods: In this two-group, repeated measures randomized control trial, the main outcomes were patient reported and clinical outcomes associated with SM adherence, and all-cause readmission at 30, 90 and 180 days. Results: The study included 100 HF patients discharged from a rural critical access hospital. The intervention group received a 12-week SM training and coaching program delivered by telephone and tailored on subjects' activation levels. At α=.10, the PATCH intervention showed significantly greater improvement compared to usual care in patient-reported SM adherence: weighing themselves, following a low-sodium diet, taking prescribed medication, and exercising daily (all p<.0005) at 3 and 6 months after discharge. In contrast, groups did not differ in physical activity assessed by actigraphy or in clinical biomarkers. Contrary to expectation, the 30-day readmission rate was significantly higher (p=.088) in the intervention group (19.6 %) than in the control group (6.1 %), with no differences at 90 or 180 days. Conclusion: It is feasible to conduct a randomized controlled trial in HF patients discharged from rural critical access hospitals. Significantly higher patient-reported SM adherence was not accompanied by lower clinical biomarkers or readmission rates. Further research is needed to understand mechanisms that influence outcomes and healthcare utilization in this population. Trial registration: Clinical Trial Registration Information: ClinicalTrials.gov; NCT01964053.
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U2 - 10.1186/s12872-016-0339-7
DO - 10.1186/s12872-016-0339-7
M3 - Article
C2 - 27608624
AN - SCOPUS:84986327415
SN - 1471-2261
VL - 16
JO - BMC Cardiovascular Disorders
JF - BMC Cardiovascular Disorders
IS - 1
M1 - 176
ER -