Heart Failure Group Appointments: Rehospitalization Prevention Clinical Trial

这项研究的主题是《跨越慢性病的自我管理策略》和《2010年健康人》 目标12-6，减少心力衰竭住院人数。心力衰竭(HF)影响了500万美国人，估计成本 每年288亿美元。然而，在2004年，只有31%的心衰患者接受了基础的JCAHO- 建议的出院教育。公共卫生可以通过高强度的HF放电和后处理来批准 医院随访计划。因此，创建了一种结合心力衰竭患者群体诊所的实用干预措施 预约/多学科讨论会议和带有患者清单的结构化自我管理 日记、算法和电话增援。这项干预是基于美国大学 心脏病学国家指南，强调患者自我管理(Bodenheimer，2005)和 理想化临床实践的医疗保健改进倡议。确保研究中的所有患者都有 国家推荐的同等高频教育每个科目都有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对复合材料的影响 再次住院或死亡的主要终点和卫生服务使用的次要终点、费用 效率、患者健康状况和心力衰竭生活质量。还测量了患者对心力衰竭的知识、自我 管理行为、家庭护理准备、专业人员的参与以及 症状报告。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。多元线性混合模型分析将是 用于测试超过12个月的干预效果。传统成本分析与创新成本-- 效率数据包络分析将用于比较群体干预成本。比较 其他高频项目的费用将被报告。长期目标是改善高频自我管理和 使用安全、成本效益高和实用的干预措施及时报告症状。集体诊所 带有讨论环节的预约支持并使患者参与自我管理(核对表 日记/症状报告算法)，加强他们的HF家庭管理，减少总体重新 住院率。

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 (Bodenheimer, 2005) 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 1treatment 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.