Heart Failure Group Appointments: Rehospitalization Prevention Clinical Trial

描述(由申请人提供)：这项研究涉及“慢性病的自我管理策略”和2010年健康人目标12-6，以减少心力衰竭的住院人数。心力衰竭(HF)影响着500万美国人，估计每年造成288亿美元的损失。然而，在2004年，只有31%的心衰患者接受了JCAHO推荐的基本出院教育。公共卫生可以通过密集的HF出院和医院后的后续计划来批准。因此，创建了一种实际干预措施，将心力衰竭患者小组诊所预约/多学科讨论会议和结构化自我管理与患者核对表日记、算法和电话增援相结合。干预是基于美国心脏病学会的国家指南，强调患者自我管理和理想化临床实践的医疗改进倡议。为了确保研究中的所有患者都接受国家推荐的同等的高频教育，我们为每个受试者提供了我们的高频录像带系列(根据SBIR 1R43AG制作)。具体目的是测试干预措施对再次住院或死亡的综合主要终点和卫生服务使用的次要终点、成本效益、患者健康状况和心力衰竭生活质量的影响。还测量了患者心力衰竭知识、自我管理行为、对家庭护理的准备、专业人员的参与以及症状报告的及时性。这是一项随机临床试验，包括1个治疗组和1个标准护理(对照组)组。每组将有92名心衰患者，总样本为184人。将使用多变量线性混合模型分析来检验干预措施在12个月内的效果。传统的成本分析和创新的成本效益数据包络分析将被用来比较群体干预成本。将报告与其他高频计划的成本比较。长期目标是使用安全、成本效益高和实用的干预措施改善心力衰竭的自我管理和及时报告症状。小组诊所预约与讨论会议支持和吸引患者进行自我管理(核对表日记/症状报告算法)，加强他们的心衰家庭管理，并降低总体再住院率。

DESCRIPTION (provided by applicant): This study addresses, "Self-Management Strategies Across Chronic Diseases" and Healthy People 2010 goal 12-6 to reduce HF hospitalizations. Heart failure (HF) affects 5 million Americans, with costs estimated at $28.8 billion annually. Yet, in 2004, only 31% of HF patients received even the basic JCAHO- recommended discharge education. Public Health can be approved by intensive HF discharge and post- hospital follow-up programs. Thus, a practical intervention was created that combines HF patient group clinic appointments/multidisciplinary discussion sessions and structured self-management with patient checklist diaries, algorithms and telephone reinforcement. The intervention is based on American College of Cardiology national guidelines, emphasizing patient self-management and the Healthcare Improvement Initiative for Idealized Clinical Practices. To assure all patients in the study have the equal and nationally recommended HF education each subject is provided with our HF videotape series (produced under SBIR 1R43AG). The specific aims are to test effects of the intervention on the composite primary endpoint of rehospitalization or death and secondary endpoints of health services use, cost efficiency, patient health status and HF quality of life. Also measured are patient HF knowledge, self- management behavior, preparedness for home care, participation with professionals and timeliness of symptom-reporting. This is a randomized clinical trial with 1 treatment and 1 standard care (control) group. Each group will have 92 HF patients, total sample of n=184. Multivariate linear mixed model analyses will be used to test effects of the intervention over 12 months. Traditional cost analysis and innovative cost- efficiency Data Envelopment Analysis will be used to compare group intervention costs. Comparisons of costs to other HF programs will be reported. The long-term goals are to improve HF self-management and timely reporting of symptoms using safe and cost-efficient and practical interventions. The group clinic appointments with discussion sessions support and engage patients in self-management (checklist diaries/symptom reporting algorithms), strengthen their HF home management and reduce overall re- hospitalization rates.