Improving Self Management and Outcomes in Heart Failure Patients with Diabetes

Sandra B. Dunbar， RN， DSN， FAAN摘要本提案旨在解决合并心力衰竭（HF）和糖尿病（DM）患者预后差和再入院率高的问题。具体目标是：1)：设计一个综合的，护士主导的方法自我管理和出院患者教育，短期随访和护理调解住院HF-DM患者；2)通过一项前瞻性研究，比较干预组和常规护理组的参与者，来测试综合的、护士主导的方法。在第一个目标中，将使用定性方法（焦点小组）来引出HF-DM患者和护理人员对这一人群的自我管理、教育和随访护理和解问题的看法。将从定性数据中提取关于急性护理后的障碍和解决方案以及短期随访时间框架的观点，重点是患者自我管理问题，这些问题将用于改进干预措施。这些数据将用于开发HF-DM自我管理干预措施和工具包。对于Aim II，一项初步随机研究将比较接受干预的HF-DM患者（n=60）与常规护理（n=30）对患者结局（HF和DM知识、自我效能、自我护理行为、生活质量、BNP和HgA1c生物标志物）和医疗保健利用率（90天内再入院率、急诊科就诊率和提供者接触率；LOS和再入院相关的护理模式使用）的影响。数据分析策略将涉及Aim I的焦点群体信息的内容分析，以及Aim II使用方差分析、比例检验和医疗保健使用模型进行未经调整和风险调整的群体手段比较。这些数据将为更大规模的随机试验提供指导，以检验干预和合并症自我保健模型。公共卫生相关性：改善糖尿病心力衰竭患者的自我管理和预后本研究的目的是设计和测试一种护士管理的干预措施，以改善糖尿病心力衰竭患者的预后。干预措施将侧重于急性护理环境中的患者教育和自我管理培训，并进行短期随访。测量的结果是知识、自我效能和自我护理行为、心力衰竭和糖尿病的生物标志物以及卫生资源的使用。

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.