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。这项建议是对RFA-NR-09-005的响应，将成本-效果分析纳入影响生活质量的健康相关研究的因素中。该提案针对心力衰竭(HF)合并糖尿病(DM)患者的生活质量下降和卫生资源使用率高而记录的患者预后差的问题。因此，本研究的目的有两个：1)开发和测试心力衰竭合并糖尿病患者的综合自我护理干预措施，以了解其对患者预后的影响，包括健康相关生活质量(HRQOL)、身体功能和卫生资源利用；2)评估干预措施的成本和成本效益。该干预措施旨在超越常规护理，通过教育HF-DM患者有关HF-DM饮食、HF-DM用药行为、体力活动以及HF-DM症状监测和管理的综合自我护理和自我管理，来提供单独的HF和DM患者教育。一项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患者和那些接受常规护理注意控制的患者，以了解对患者结局的影响(HF和DM疾病特有的HRQOL，BNP和HgA1c的生物标记物)自我护理过程措施(HF和DM的自我效能、知识和自我护理行为)，以及卫生保健利用(6个月内再次入院、急诊室就诊和意外接触提供者的比率；LOS，以及与再次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，干预将导致改善自我护理，提高生活质量，并减少卫生保健资源的使用和成本。这项研究将有助于在两种慢性病的背景下更好地理解自我护理，并将直接导致改善临床实践和未来关于心力衰竭患者并发自我护理的研究。意义：这项研究旨在提高患者的生活质量，减少卫生资源的使用，这些患者预计将进行与两种慢性病-心力衰竭和糖尿病-相关的复杂自我护理。这项研究的意义在于，与高水平的预期自我护理相关的潜在的患者和社会负担的减轻。 公共卫生相关性：叙述：这项研究将探讨心力衰竭和伴随的糖尿病患者的自我护理行为。其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.