Improving Self Management and Outcomes in Heart Failure Patients with Diabetes

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DESCRIPTION (provided by applicant): Improving Self Management and Outcomes in Heart Failure Patients with Diabetes Sandra B. Dunbar, RN, DSN, FAAN Abstract This proposal addresses the problems of poor patient outcomes and high readmission rates in patients with concomitant heart failure (HF) and diabetes mellitus (DM). The specific aims are to 1): Design an integrated, nurse-led approach to self management and discharge patient education, short term follow up and care reconciliation for hospitalized patients with HF-DM; and 2) Test the integrated, nurse-led approach through a prospective study comparing intervention participants with a usual care group. For Aim I, qualitative methods (focus groups) will be used to elicit HF-DM patient and caregiver perceptions of self management, education and follow up care reconciliation problems for this population. Perspectives regarding barriers and solutions after acute care and in the short term follow-up time frame will be extracted from the qualitative data with emphasis on patient self management issues which will be used to refine the intervention. These data will be used to develop a HF-DM self management intervention and tool kit. For Aim II, a preliminary randomized study will compare HF-DM patients who receive the intervention (n=60) with usual care (n=30) for effects on patient outcomes (HF and DM knowledge, self efficacy, and self care behaviors, Quality of Life, and biomarkers of BNP and HgA1c), and health care utilization (rates of readmissions, ED visits and provider contacts at 90 days; LOS, and care pattern use associated with readmission). Data analytic strategies will involve content analysis of the focus group information for Aim I, and both unadjusted and risk adjusted comparison of group means using ANOVA, proportion testing, and health care use models for Aim II. These data will provide direction for a larger randomized trial testing the intervention and comorbidity self care model. Public Health Relevance: Improving Self Management and Outcomes for Heart Failure Patients with Diabetes The purpose of this study is to design and test a nurse managed intervention to improve outcomes in heart failure patients with diabetes. The intervention will focus on patient education and self management training in the acute care setting with short term follow-up. The outcomes to be measured are knowledge, self efficacy, and self care behaviors, biomarkers of heart failure and diabetes, and health resource use.