HF Patient Decision Making Prior to Rehospitalization

描述（由申请人提供）：心力衰竭（HF）患者再次住院是常见的，因为HF的轨迹以疾病的突然急性恶化为特征。近1/5的医保HF患者在出院后30天内再次住院，每年造成美国HF费用近400亿美元。随着婴儿潮一代人口的老龄化，这些成本将在未来迅速增加。最近的医疗保险报销变化对HF相关的30天住院进行了严厉的处罚，增加了HF对医疗保健系统日益增加的经济负担。尽管通过加强心衰教育、出院后医疗支持和远程医疗计划，努力防止不必要的心衰住院，但再住院率仍然很高。目前的心衰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，这表明需要检查和探索其他患者特征，如医疗决策。心衰患者再住院前的决策是复杂的，多方面的，并且知之甚少。2012年，美国心脏协会（AHA）关于晚期心衰患者决策的科学报告指出，临床医生迫切需要了解心衰患者的决策，以促进有效、及时、

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.