Randomized trial of an education and support intervention to prevent readmission of patients with heart failure
Randomized trial of an education and support intervention to prevent readmission of patients with heart failure
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DOI：
10.1016/s0735-1097(01)01699-0
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发表时间：
2002-01-02
影响因子：
24
通讯作者：
Vaccarino, V
中科院分区：
文献类型：
--
作者：
Krumholz, HM;Amatruda, J;Vaccarino, V
目的研究有针对性的教育和支持干预对心力衰竭患者再入院或死亡率和住院费用的影响。背景针对心力衰竭患者的疾病管理方案包括医疗部分，可使再入院患者减少40%或更多，但以教育和支持为重点的干预措施的价值尚不清楚。方法我们对88名心力衰竭患者(44名干预和44名对照)进行了一项前瞻性随机试验，对心力衰竭患者住院一年的再入院或死亡率和护理费用进行了正式的教育和支持干预。干预组25例(56.8%)和对照组36例(81.8%)在1年随访期间至少再入院一次或死亡(相对危险度=0.69，95%可信区间[CI]：0.52，0.92；P=0.01)。干预与再入院总次数减少39%相关(干预组：49人再入院；对照组：80人再入院，p=0.06)。在调整了临床和人口学特征后，干预组与对照组相比，再入院风险显著降低(风险比=0.56，95%CI：0.32，0.96；p=0.03)，每名患者再入院费用减少7,515美元。(J Am Coll心脏ol 2002；39：83-9)(C)2002，由美国心脏病学会出版。
OBJECTIVES We determined the effect of a targeted education and support intervention on the rate of readmission or death and hospital costs in patients with heart failure (HF).BACKGROUND Disease management programs for patients with HF including medical components may reduce readmissions by 40% or more, but the value of an intervention focused on education and support is not known.METHODS We conducted a prospective, randomized trial of a formal education and support intervention on one-year readmission or mortality and costs of care for patients hospitalized with HF.RESULTS Among the 88 patients (44 intervention and 44 control) in the study, 25 patients (56.8%) in the intervention group and 36 patients (81.8%) in the control group had at least one readmission or died during one-year follow-up (relative risk = 0.69, 95% confidence interval [CI]: 0.52, 0.92; p = 0.01). The intervention was associated with a 39% decrease in the total number of readmissions (intervention group: 49 readmissions; control group: 80 readmissions, p = 0.06). After adjusting for clinical and demographic characteristics, the intervention group had a significantly lower risk of readmission compared with the control group (hazard ratio = 0.56, 95% CI: 0.32, 0.96; p = 0.03) and hospital readmission costs of $7,515 less per patient.CONCLUSIONS A formal education and support intervention substantially reduced adverse clinical outcomes and costs for patients with HF. (J Am Coll Cardiol 2002;39:83-9) (C) 2002 by the American College of Cardiology.