Cost Effectiveness and Quality of Life in Heart Failure Patients with Diabetes

描述（由申请人提供）：糖尿病心力衰竭患者的成本效益和生活质量。本提案是对RFA RFA-NR-09-005《将成本效益分析纳入影响生活质量健康相关研究的因素》的回应。该提案解决了伴有糖尿病（DM）的心力衰竭（HF）患者的生活质量降低和高卫生资源使用所记录的患者结局不良的问题。因此，本研究的目的有两个：1）开发和测试HF合并DM患者的综合自我护理干预对患者结局的影响，包括健康相关生活质量（HRQOL）、身体功能和卫生资源利用; 2）评估干预的成本和成本效益。该干预措施旨在通过教育HF-DM患者进行与HF-DM饮食、HF-DM用药行为、体力活动和HF-DM症状监测和管理相关的综合自我护理和自我管理，超越提供单独HF和DM患者教育的常规护理。综合自我护理干预的随机试验（n=132）将比较接受干预的HF-DM患者与接受常规护理-注意控制的HF-DM患者对患者结局的影响（HF和DM疾病特异性HRQOL，BNP和HgA 1c的生物标志物）自我护理过程测量（HF和DM自我效能、知识和自我护理行为）和卫生保健利用（六个月内的再入院率、艾德就诊率和计划外提供者联系率; LOS和与再入院相关的护理模式使用率）。数据分析策略将涉及使用ANOVA、比例检验和医疗保健使用模型对干预和常规护理组数据进行未经调整和风险调整的比较。将构建成本效益比。如果有效，干预措施将改善自我保健，提高生活质量，减少医疗资源的使用和成本。这项研究将有助于更好地了解自我护理的背景下，两种慢性疾病，并将直接导致改善临床实践和未来的研究共病自我护理在HF。重要性：这项研究旨在改善生活质量，减少预期与两种慢性疾病（心力衰竭和糖尿病）相关的复杂自我护理患者的卫生资源使用。该研究的意义在于潜在地减少了与高水平的预期自我护理相关的患者和社会负担。 公共卫生相关性：叙述：本研究将探讨心力衰竭伴发糖尿病患者的自我护理行为。目标是提高生活质量，减少医疗保健的使用和成本。

DESCRIPTION (provided by applicant): Cost Effectiveness and Quality of Life in Heart Failure Patients with Diabetes. This proposal is in response to the RFA RFA-NR-09-005, Incorporating Cost-Effectiveness Analysis into Factors Affecting Quality of Life Health Related Research. The proposal addresses the problems of poor patient outcomes documented by reduced quality of life and high health resource use in heart failure (HF) patients with concomitant diabetes mellitus (DM). Therefore, the purposes of this study are twofold: 1) to develop and test an integrated self care intervention for HF patients with DM for its effects on patient outcomes including health related quality of life (HRQOL), physical function and health resource utilization and 2) to assess the costs and cost effectiveness of the intervention. The intervention is designed to go beyond usual care of providing separate HF and DM patient education by educating HF-DM patients on integrated self care and self management related to a HF-DM diet, HF-DM medication-taking behaviors, physical activity, and HF- DM symptom monitoring and management. A randomized test (n=132) of the integrated self care intervention will compare HF-DM patients who receive the intervention with those who receive usual care-attention control for effects on patient outcomes (HF and DM disease specific HRQOL, biomarkers of BNP and HgA1c) self care process measures (HF and DM self efficacy, knowledge and self care behaviors), and health care utilization (rates of readmissions, ED visits and unplanned provider contacts over the six months; LOS, and care pattern use associated with readmission). Data analytic strategies will involve both unadjusted and risk adjusted comparison of intervention and usual care group data using ANOVA, proportion testing, and health care use models. Cost effectiveness ratio will be constructed. If effective, the intervention will lead to improved self care, improved quality of life, and reduced health care resource use and costs. This study will facilitate greater understanding of self care within the context of two chronic illnesses and will lead directly to improved clinical practice and future research on comorbid self care in HF. Significance: This study is designed to improve quality of life and reduce health resource use in patients who are expected to perform complicated self care associated with two chronic illnesses, heart failure and diabetes. The significance of the study is in the potential reduced patient and societal burden associated with a high level of expected self care. PUBLIC HEALTH RELEVANCE: Narrative: this study will address self care behaviors among patients with heart failure and concomitant diabetes mellitus. The goal is to improve quality of life and reduce health care use and costs.