Improving Self Management and Outcomes in Heart Failure Patients with Diabetes

描述（由申请人提供）：改善糖尿病心力衰竭患者的自我管理和结局Sandra B。Dunbar，RN，DSN，FAAN摘要该提案解决了合并心力衰竭（HF）和糖尿病（DM）患者的不良患者结局和高再入院率的问题。具体目标是：1）：设计一个综合的，护士主导的自我管理和出院患者教育，短期随访和护理协调的HF-DM住院患者的方法;和2）通过一项前瞻性研究，比较干预参与者与常规护理组测试的综合，护士主导的方法。对于目标I，定性方法（焦点小组）将用于引出HF-DM患者和护理人员对该人群自我管理、教育和随访护理协调问题的看法。将从定性数据中提取关于急性护理后和短期随访时间范围内的障碍和解决方案的观点，重点是患者自我管理问题，这些问题将用于完善干预措施。这些数据将用于开发HF-DM自我管理干预和工具包。对于目标II，初步随机研究将比较接受干预（n=60）和常规护理（n=30）的HF-DM患者对患者结局的影响（HF和DM知识、自我效能和自我护理行为、生活质量以及BNP和HgA 1c的生物标志物）和医疗保健利用（90天时的再入院率、艾德就诊率和提供者联系率; 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针对目标I的焦点组信息的内容分析，以及针对目标II使用ANOVA、比例检验和医疗保健使用模型对组平均值进行未经调整和风险调整的比较。这些数据将为更大规模的随机试验提供指导，以测试干预和合并症自我护理模型。公共卫生相关性：改善糖尿病心力衰竭患者的自我管理和预后本研究的目的是设计和测试护士管理的干预措施，以改善糖尿病心力衰竭患者的预后。干预措施的重点是在急性护理环境中进行患者教育和自我管理培训，并进行短期随访。要测量的结果是知识，自我效能和自我护理行为，心力衰竭和糖尿病的生物标志物，以及卫生资源的使用。

DESCRIPTION (provided by applicant): Improving Self Management and Outcomes in Heart Failure Patients with Diabetes Sandra B. Dunbar, RN, DSN, FAAN Abstract This proposal addresses the problems of poor patient outcomes and high readmission rates in patients with concomitant heart failure (HF) and diabetes mellitus (DM). The specific aims are to 1): Design an integrated, nurse-led approach to self management and discharge patient education, short term follow up and care reconciliation for hospitalized patients with HF-DM; and 2) Test the integrated, nurse-led approach through a prospective study comparing intervention participants with a usual care group. For Aim I, qualitative methods (focus groups) will be used to elicit HF-DM patient and caregiver perceptions of self management, education and follow up care reconciliation problems for this population. Perspectives regarding barriers and solutions after acute care and in the short term follow-up time frame will be extracted from the qualitative data with emphasis on patient self management issues which will be used to refine the intervention. These data will be used to develop a HF-DM self management intervention and tool kit. For Aim II, a preliminary randomized study will compare HF-DM patients who receive the intervention (n=60) with usual care (n=30) for effects on patient outcomes (HF and DM knowledge, self efficacy, and self care behaviors, Quality of Life, and biomarkers of BNP and HgA1c), and health care utilization (rates of readmissions, ED visits and provider contacts at 90 days; LOS, and care pattern use associated with readmission). Data analytic strategies will involve content analysis of the focus group information for Aim I, and both unadjusted and risk adjusted comparison of group means using ANOVA, proportion testing, and health care use models for Aim II. These data will provide direction for a larger randomized trial testing the intervention and comorbidity self care model. Public Health Relevance: Improving Self Management and Outcomes for Heart Failure Patients with Diabetes The purpose of this study is to design and test a nurse managed intervention to improve outcomes in heart failure patients with diabetes. The intervention will focus on patient education and self management training in the acute care setting with short term follow-up. The outcomes to be measured are knowledge, self efficacy, and self care behaviors, biomarkers of heart failure and diabetes, and health resource use.