Discharge education improves clinical outcomes in patients with chronic heart failure
Discharge education improves clinical outcomes in patients with chronic heart failure
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DOI：
10.1161/01.cir.0000151811.53450.b8
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发表时间：
2005-01-18
期刊：
影响因子：
37.8
通讯作者：
Aaronson, KD
中科院分区：
文献类型：
--
作者：
Koelling, TM;Johnson, ML;Aaronson, KD
背景-尽管结合患者教育和出院后管理的干预措施已证明对慢性心力衰竭患者有益，但仅患者教育的益处尚不清楚。我们假设患者出院教育计划可以改善慢性心力衰竭患者的临床结果。方法和结果：我们对223名收缩期心力衰竭患者进行了一项随机对照试验，并比较了护士教育者1小时一对一教学与标准出院过程的效果。在第30、90和180天通过电话联系受试者，收集有关临床事件、症状和自我保健实践的信息。研究的主要终点是180天随访期间住院或死亡的总天数。随机接受教学课程的受试者（n = 107）在随访期间（0天和10天，中位数和75百分位数）住院或死亡天数少于对照组（n = 116、4和19天，P = 0.009）。接受教育干预的患者再住院或死亡的风险较低（相对风险为0.65；95%可信区间为0.45 ~ 0.93;P = 0.018）。接受教育干预的患者的护理费用（包括干预费用）比对照组低2823美元（P = 0.035）。结论：在收缩期心力衰竭患者出院时，增加1小时的护士教育课程可改善临床结果，提高自我保健措施的依从性，并降低护理成本。
Background - Although interventions combining patient education and postdischarge management have demonstrated benefits in patients with chronic heart failure, the benefit attributable to patient education alone is not known. We hypothesized that a patient discharge education program would improve clinical outcomes in patients with chronic heart failure.Methods and Results - We conducted a randomized, controlled trial of 223 systolic heart failure patients and compared the effects of a 1-hour, one-on-one teaching session with a nurse educator to the standard discharge process. Subjects were contacted by telephone at 30, 90, and 180 days to collect information about clinical events, symptoms, and self-care practices. The primary end point of the study was the total number of days hospitalized or dead in the 180-day follow-up period. Subjects randomized to receive the teaching session (n = 107) had fewer days hospitalized or dead in the follow-up period (0 and 10 days, median and 75th percentiles) than did controls (n = 116, 4 and 19 days; P = 0.009). Patients receiving the education intervention had a lower risk of rehospitalization or death ( relative risk, 0.65; 95% confidence interval, 0.45 to 0.93; P = 0.018). Costs of care, including the cost of the intervention, were lower in patients receiving the education intervention than in control subjects by $2823 per patient ( P = 0.035).Conclusions - The addition of a 1-hour, nurse educator - delivered teaching session at the time of hospital discharge resulted in improved clinical outcomes, increased self-care measure adherence, and reduced cost of care in patients with systolic heart failure.