HF Patient Decision Making Prior to Rehospitalization

描述(由申请人提供)：心力衰竭(HF)患者再次住院是很常见的，因为心力衰竭的轨迹以疾病的突然、急性恶化为标志。参加医疗保险的心力衰竭患者中，近五分之一在出院后30天内再次住院，这导致美国每年的心力衰竭成本接近400亿美元。随着婴儿潮一代人口的老龄化，这些成本在未来将迅速增加。最近的医疗保险报销变化对与心力衰竭相关的30天住院给予了重罚，增加了心力衰竭给医疗保健系统带来的日益沉重的经济负担。尽管努力通过增加心力衰竭教育、出院后的医疗支持和远程医疗计划来防止不必要的心力衰竭住院，但再住院率仍然很高。目前的心力衰竭住院预测模型使用的患者特征(如年龄、种族、合并症)不能一致或强烈地预测再入院--这表明有必要检查和探索其他患者特征，如医疗决策。心力衰竭患者在再次住院前的决策是复杂的、多方面的，也很难被理解。2012年，美国心脏协会(AHA)关于晚期心力衰竭患者决策的科学报告指出，临床医生迫切需要了解心力衰竭患者的决策，以促进有效、及时、 高效、安全、以病人为中心的护理。此外，目前尚不清楚在30天内和30天后再次住院的心衰患者之间的决策过程是否有所不同。这项研究的主要目的是比较：(1)心衰患者的自我护理，(2)决策延迟，(3)入院前的决策，以及(3)在30天内和30天后再住院的心力衰竭患者。这项研究以改良的自然主义决策框架为指导，采用趋同的平行混合方法设计，深入了解心力衰竭患者的决策过程，重点关注自我护理和决策延迟这两个关键的可修改变量。心衰患者将被要求完成一项调查，并在再次住院之前参与关于他们决策的采访。拟议的研究直接与 国家护理研究所(NINR)的战略计划，以制定战略，帮助患者更好地管理他们的慢性病。

DESCRIPTION (provided by applicant): Rehospitalizations among heart failure (HF) patients are common due to a HF trajectory marked by sudden, acute exacerbations of illness. Nearly 1/5 of HF patients with Medicare are rehospitalized within 30 days of discharge, contributing to United States (US) HF costs of nearly 40 billion dollars a year. With the aging of the baby boomer population, these costs will rapidly increase in the future. Recent Medicare reimbursement changes place heavy penalties for 30 day hospitalizations related to HF, adding to the increasing financial burden of HF on the health care system. Despite efforts to prevent unnecessary HF hospitalizations through increased HF education, medical support after discharge, and telehealth programs, rehospitalization rates remain high. Current hospitalization prediction models for HF use patient characteristics (e.g. age, race, comorbidities) that do not consistently or strongly predict readmission -suggesting the need to examine and explore other patient characteristics such as medical decision making. Decision making in HF patients prior to being rehospitalized is complex, multifaceted, and poorly understood. In 2012, the American Heart Association (AHA) scientific report on decision making in advanced HF, identified the critical need for clinicians to understand HF patient decision making to promote effective, timely, efficient, and safe patient-centered care. Additionally, it is unknown if decision making processes differ between HF patients who have been rehospitalized within and beyond 30 days. The main goal of the study is to compare: (1) HF self-care, (2) decisional delays, and (3) decisions prior to hospitalization between HF patients who are rehospitalized within and beyond 30 days. The study, guided by a modified naturalistic decision making framework, uses a convergent parallel mixed-methods design to gain an in-depth understanding of the HF patient's decision making process with a focus on the critical modifiable variables of self-care and decisional delay. HF patients will be asked to complete a survey and participate in an interview about their decision making prior to rehospitalization. The proposed study is directly aligned with the National Institute of Nursing Research's (NINR) strategic plan to develop strategies that assist patients in better managing their chronic illness.