Heart Failure Group Appointments: Rehospitalization Prevention Clinical Trial

描述（由申请人提供）：本研究针对“跨越慢性疾病的自我管理策略”和健康人2010目标12-6减少心衰住院率。心力衰竭（HF）影响了500万美国人，每年造成的损失估计为288亿美元。然而，在2004年，只有31%的心衰患者接受了JCAHO推荐的基本出院教育。公共卫生可以通过加强心衰出院和院后随访计划得到批准。因此，创建了一种实用的干预措施，将心衰患者群体门诊预约/多学科讨论会议和结构化的自我管理与患者清单日记、算法和电话强化相结合。干预是基于美国心脏病学会国家指南，强调患者自我管理和理想临床实践的医疗保健改善倡议。为了确保研究中的所有患者都能获得平等的和国家推荐的心衰教育，每位受试者都获得了我们的心衰录像带系列（根据SBIR 1R43AG制作）。具体目的是测试干预对复合主要终点（再住院或死亡）和次要终点（卫生服务使用、成本效率、患者健康状况和心衰生活质量）的影响。还测量了患者心衰知识、自我管理行为、家庭护理准备、专业人员的参与和症状报告的及时性。这是一项随机临床试验，1个治疗组和1个标准护理组（对照组）。每组92例HF患者，总样本数n=184。将使用多元线性混合模型分析来测试12个月以上的干预效果。传统的成本分析和创新的成本效率数据包络分析将被用来比较群体干预的成本。将报告与其他HF项目的成本比较。长期目标是使用安全、经济、实用的干预措施改善心衰自我管理和及时报告症状。小组门诊预约和讨论会议支持并使患者参与自我管理（检查表日记/症状报告算法），加强心衰家庭管理，降低总体再住院率。

DESCRIPTION (provided by applicant): 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 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 1 treatment 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.