Leveraging Home Health Aides to Improve Outcomes in Heart Failure

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Project Summary/Abstract Heart failure (HF) affects 6 million people in the US, costs over $30 billion per year, and results in 1 million hospitalizations per year. Readmission within 30 days occurs in 25% of Medicare beneficiaries admitted for HF, but previous interventions to reduce readmissions have had mixed results. An untapped potential resource for such interventions may be to engage home health aides (HHAs); after a HF hospitalization, 25% of patients are discharged home with support from HHAs. Unlike physicians or visiting nurses, HHAs are with patients on a near-daily basis, sometimes up to 24 hours per day. However, the candidate’s prior work suggests that HHAs do not receive HF-specific education and lack confidence caring for HF patients. Indeed, HHAs acknowledge that they often call 911 when they are unsure of what to do, or if they cannot reach their agency nurse for advice. While some emergency department visits may be clinically appropriate, many may be avoidable. The objective of this proposal is to design and test a novel intervention that will educate HHAs about HF and provide them with a tablet-based messaging tool that connects them with their supervising nurses. The overall hypothesis is that educated and integrated HHAs can improve outcomes in HF. Building on established community-based collaborations, the project will be conducted with the 1199SEIU-Home Care Industry Education Fund (an organization that trains 75,000 HHAs from 55 licensed home care agencies in New York, NY) and the Visiting Nurse Service of New York (the largest non-profit licensed home care agency in the U.S.). The project will include a survey of HHAs to measure the prevalence of HF training gaps and preferences for an intervention (Aim 1); a stakeholder-engaged process to design an educational and communication-based intervention (Aim 2); and a pilot randomized controlled trial to test the feasibility and acceptability of the intervention (Aim 3), laying the groundwork for a future R01 which will test its effectiveness on a larger scale. The candidate for this career development award, Madeline Sterling, MD, MPH, MS, is a general internist with expertise in clinical medicine, epidemiology, and health services research. This award will enable her to gain skills in the development and conduct of clinical trials in real-world settings designed to improve healthcare delivery and outcomes for HF patients. Dr. Sterling will be mentored by two NHBLI-funded clinician- investigators, Monika Safford, MD (primary mentor; expert in real-world clinical trials) and Lisa Kern, MD, MPH (co-mentor; expert in the evaluation of interventions designed to improve ambulatory care). Other advisors with expertise in HF, home care, technology, and implementation science will also guide her. The combination of mentorship, formal coursework, and the proposed experiential learning will position Dr. Sterling to become an independent investigator while advancing the field of home care and healthcare delivery for HF patients.