Cost Effectiveness and Quality of Life in Heart Failure Patients with Diabetes

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DESCRIPTION (provided by applicant): Cost Effectiveness and Quality of Life in Heart Failure Patients with Diabetes. This proposal is in response to the RFA RFA-NR-09-005, Incorporating Cost-Effectiveness Analysis into Factors Affecting Quality of Life Health Related Research. The proposal addresses the problems of poor patient outcomes documented by reduced quality of life and high health resource use in heart failure (HF) patients with concomitant diabetes mellitus (DM). Therefore, the purposes of this study are twofold: 1) to develop and test an integrated self care intervention for HF patients with DM for its effects on patient outcomes including health related quality of life (HRQOL), physical function and health resource utilization and 2) to assess the costs and cost effectiveness of the intervention. The intervention is designed to go beyond usual care of providing separate HF and DM patient education by educating HF-DM patients on integrated self care and self management related to a HF-DM diet, HF-DM medication-taking behaviors, physical activity, and HF- DM symptom monitoring and management. A randomized test (n=132) of the integrated self care intervention will compare HF-DM patients who receive the intervention with those who receive usual care-attention control for effects on patient outcomes (HF and DM disease specific HRQOL, biomarkers of BNP and HgA1c) self care process measures (HF and DM self efficacy, knowledge and self care behaviors), and health care utilization (rates of readmissions, ED visits and unplanned provider contacts over the six months; LOS, and care pattern use associated with readmission). Data analytic strategies will involve both unadjusted and risk adjusted comparison of intervention and usual care group data using ANOVA, proportion testing, and health care use models. Cost effectiveness ratio will be constructed. If effective, the intervention will lead to improved self care, improved quality of life, and reduced health care resource use and costs. This study will facilitate greater understanding of self care within the context of two chronic illnesses and will lead directly to improved clinical practice and future research on comorbid self care in HF. Significance: This study is designed to improve quality of life and reduce health resource use in patients who are expected to perform complicated self care associated with two chronic illnesses, heart failure and diabetes. The significance of the study is in the potential reduced patient and societal burden associated with a high level of expected self care. PUBLIC HEALTH RELEVANCE: Narrative: this study will address self care behaviors among patients with heart failure and concomitant diabetes mellitus. The goal is to improve quality of life and reduce health care use and costs.