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

描述（由申请人提供）：心力衰竭合并糖尿病患者的成本效益和生活质量。本提案是响应RFA- nr -09-005，将成本效益分析纳入影响生活质量的因素健康相关研究。该建议解决了伴有糖尿病（DM）的心力衰竭（HF）患者生活质量下降和高卫生资源使用所记录的患者预后不良的问题。因此，本研究的目的有两个：1)开发和测试一种针对HF合并DM患者的综合自我护理干预措施，以了解其对患者健康相关生活质量（HRQOL）、身体功能和健康资源利用等预后的影响；2)评估干预措施的成本和成本效益。该干预措施旨在通过对HF-DM患者进行与HF-DM饮食、HF-DM服药行为、身体活动以及HF-DM症状监测和管理相关的综合自我护理和自我管理教育，从而超越对HF和DM患者进行单独教育的常规护理。一项针对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-注意控制的患者在患者结局（HF和DM疾病特异性HRQOL、BNP和HgA1c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）和医疗保健利用(6个月内再入院率、急诊科就诊率和计划外提供者接触率；LOS，以及与再入院相关的护理模式使用)。数据分析策略将包括使用方差分析、比例检验和卫生保健使用模型对干预组和常规护理组数据进行未经调整和风险调整的比较。构建成本效益比。如果有效，干预将导致改善自我护理，改善生活质量，并减少卫生保健资源的使用和成本。本研究将有助于更好地了解两种慢性疾病背景下的自我保健，并将直接改善心衰共病自我保健的临床实践和未来研究。意义：本研究旨在改善合并心力衰竭和糖尿病两种慢性疾病的复杂自我护理患者的生活质量，减少健康资源的使用。该研究的意义在于，与高水平的预期自我护理相关的潜在患者和社会负担减轻。

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.