Does increased access to primary care reduce hospital readmissions? Veterans Affairs Cooperative Study Group on Primary Care and Hospital Readmission. Impact of care at a multidisciplinary congestive heart failure clinic: a randomized trial Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Telemonitoring of heart failure patients and their caregivers: a pilot randomized controlled trial. Managing heart failure patients after formal homecare. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. Evaluation of home telehealth following hospitalization for heart failure: a randomized trial. Care Management for Low-Risk Patients with Heart Failure Quality of Life of Individuals With Heart Failure: A Randomized Trial of the Effectiveness of Two Models of Hospital-to-Home Transition Impact of a nurse-managed heart failure clinic: a pilot study. The Comparison of the Effects of Education Provided by Nurses on the Quality of Life in Patients with Congestive Heart Failure (CHF) in Usual and Home-Visit Cares in Iran Home telehealth reduces healthcare costs. [Evaluation of a home-based intervention in heart failure patients. Results of a randomized study]. Long-term implications of a single home-based educational intervention in patients with heart failure. Pilot study to determine the impact of a multidisciplinary educational intervention in patients hospitalized with heart failure. A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home-HF study. The effect of family training and support on the quality of life and cost of hospital readmissions in congestive heart failure patients in Iran. The effect of a randomized trial of home telemonitoring on medical costs, 30-day readmissions, mortality, and health-related quality of life in a cohort of community-dwelling heart failure patients. Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. Depressive symptoms and quality of life in elderly patients with exacerbation of chronic obstructive pulmonary disease or cardiac heart failure: preliminary data of a randomized controlled trial. Effectiveness of transcendental meditation on functional capacity and quality of life of African Americans with congestive heart failure: a randomized control study. Peripheral muscle training in patients with clinical signs of heart failure. Impact of an emergency department-initiated clinical protocol for the evaluation and treatment of atrial fibrillation.
BACKGROUND For chronically ill patients , readmission to the hospital can be frequent and costly . We studied the effect of an intervention design ed to increase access to primary care after discharge from the hospital , with the goals of reducing readmissions and emergency department visits and increasing patients ' quality of life and satisfaction with care . METHODS In a multicenter r and omized , controlled trial at nine Veterans Affairs Medical Centers , we r and omly assigned 1396 veterans hospitalized with diabetes , chronic obstructive pulmonary disease , or congestive heart failure to receive either usual care or an intensive primary care intervention . The intervention involved close follow-up by a nurse and a primary care physician , beginning before discharge and continuing for the next six months . RESULTS The patients were severely ill . Half of those with congestive heart failure ( 504 patients ) had disease in New York Heart Association class III or IV ; 30 percent of those with diabetes ( 751 patients ) had end-organ damage ; and a quarter of those with chronic obstructive pulmonary disease ( 583 patients ) required home oxygen treatment or oral corticosteroids  . The patients had extremely poor quality -of-life scores . Although they received more intensive primary care than the controls , the patients in the intervention group had significantly higher rates of readmission ( 0.19 vs 0.14 per month , P = 0.005 ) and more days of rehospitalization ( 10.2 vs 8.8 , P = 0.041 ) . The patients in the intervention group were more satisfied with their care ( P < 0.001 ) , but there was no difference between the study groups in quality -of-life scores , which remained very low ( P = 0.53 ) . CONCLUSIONS For veterans discharged from Veterans Affairs hospitals , the primary care intervention we studied increased rather than decreased the rate of rehospitalization , although patients in the intervention group were more satisfied with their care Background : Although multidisciplinary congestive heart failure clinics in the United States appear to be effective in reducing the number of hospital readmissions , it is unclear whether the same benefit is seen in countries such as Canada , where access to both general and specialized medical care is free and unrestricted . We sought to determine the impact of care at a multidisciplinary specialized outpatient congestive heart failure clinic compared with st and ard care . Methods : We r and omly assigned 230 eligible patients who had experienced an acute episode of congestive heart failure to st and ard care ( n = 115 ) or follow-up at a multidisciplinary specialized heart failure outpatient clinic ( n = 115 ) . The intervention consisted of a structured outpatient clinic environment with complete access to cardiologists and allied health professionals . The primary outcomes were all-cause hospital admission rates and total number of days in hospital at 6 months . The secondary outcomes were total number of emergency department visits , quality of life and total mortality . Results : At 6 months , fewer patients in the intervention group had required readmission to hospital than patients in the control group ( 45 [ 39 % ] v. 66 [ 57 % ] , crude hazard ratio [ HR ] 0.59 , 95 % confidence interval [ CI ] 0.38–0.92 . Patients in the intervention group stayed in hospital for 514 days compared with 815 days required by patients in the control group ( adjusted HR 0.56 , 95 % CI 0.35–0.89 ) . The number of patients seen in the emergency department and the total number of emergency department visits were similar in the intervention and control groups . At 6 months , quality of life , which was self-assessed using the Minnesota Living with Heart Failure question naire , was unchanged in the control group but improved in the intervention group ( p < 0.001 ) . No difference in mortality was observed , with 19 deaths in the control group and 12 in the intervention group ( HR 0.61 , 95 % CI 0.24–1.54 ) . Interpretation : Compared with usual care , care at a multidisciplinary specialized congestive heart failure outpatient clinic reduced the number of hospital readmissions and hospital days and improved quality of life . When our results are integrated with those from other , similar trials , multidisciplinary disease management strategies for congestive heart failure are associated with clinical ly worthwhile improvements in survival PURPOSE Telehealth care is emerging as a viable intervention model to treat complex chronic conditions , such as heart failure ( HF ) and chronic obstructive pulmonary disease ( COPD ) , and to engage older adults in self-care disease management . DESIGN AND METHODS We report on a r and omized controlled trial examining the impact of a multifaceted telehealth intervention on health , mental health , and service utilization outcomes among homebound medically ill older adults diagnosed with HF or COPD . R and om effects regression modeling was used , and we hypothesized that older adults in the telehealth intervention ( n = 51 ) would receive significantly better quality of care result ing in improved scores in health-related quality of life , mental health , and satisfaction with care at 3 months follow-up as compared with controls ( n = 51 ) and service utilization outcomes at 12 months follow-up . RESULTS At follow-up , the telehealth intervention group reported greater increases in general health and social functioning , and improved in depression symptom scores as compared with usual care plus education group . The control group had significantly more visits to the emergency department than the telehealth group . There was an observed trend toward fewer hospital days for telehealth participants , but it did not reach significance at 12 months . IMPLICATION S Telehealth may be an efficient and effective method of systematic ally delivering integrated care in the home health sector . The use of telehealth technology may benefit homebound older adults who have difficulty accessing care due to disability , transportation , or isolation Heart failure ( HF ) is the leading cause of rehospitalization in older adults . The purpose of this pilot study was to examine whether telemonitoring by an advanced practice nurse reduced subsequent hospital readmissions , emergency department visits , costs , and risk of hospital readmission for patients with HF . One hundred two patient/caregiver dyads were r and omized into 2 groups postdischarge ; 84 dyads completed the study . Hospital readmissions , emergency department visits , costs , and days to readmission were abstract ed from medical records . Participants were interviewed soon after discharge and 3 months later about effects of telemonitoring on depressive symptoms , quality of life , and caregiver mastery . There were no significant differences due to telemonitoring for any outcomes . Caregiver mastery , informal social support , and electronic home monitoring were not significant predictors for risk of hospital readmission . Further studies should address the interaction between the advanced practice nurse and follow-up intervention with telemonitoring of patients with HF to better target those who are most likely to benefit The aim of this study was to determine whether using a teleheath system after discharge from formal home health services would improve clinical outcomes and self-management behaviors .  Patients were recruited from 10 home health agencies ( HHAs ) across the United States . All patients used the Health Buddy telehealth system  during formal home health services . Patients were r and omly assigned to either the telehealth group or the control group  upon discharge from the HHA . Patients in the telehealth group used the Health Buddy for an additional 180 days ; patients in the control group received no further telehealth or home health services . Results show that patients who continued using telehealth beyond the formal episode of care showed greater improvements in respiratory status and activities of daily living . None of the patients who used telehealth during this stage had any hospitalizations or Emergency Department ( ED ) events , while 28.3 % of the control group patients required hospitalization and 26.1 % had at least one ED visit . Telehealth patients were more likely to report that they measured their weights daily , and were more likely to report an increase in diuretic dose following sudden weight gain , ankle swelling , or shortness of breath . We conclude that patients with heart failure may benefit from continued use of telehealth following formal home health services . Results of this study will inform managers and clinicians who are responsible for integrating telehealth into chronic disease protocol OBJECTIVES To examine the effectiveness of a transitional care intervention delivered by advanced practice nurses ( APNs ) to elders hospitalized with heart failure . DESIGN R and omized , controlled trial with follow-up through 52 weeks postindex hospital discharge . SETTING Six Philadelphia academic and community hospitals . PARTICIPANTS Two hundred thirty-nine eligible patients were aged 65 and older and hospitalized with heart failure . INTERVENTION A 3-month APN-directed discharge planning and home follow-up protocol . MEASUREMENTS Time to first rehospitalization or death , number of rehospitalizations , quality of life , functional status , costs , and satisfaction with care . RESULTS Mean age of patients ( control n=121 ; intervention n=118 ) enrolled was 76 ; 43 % were male , and 36 % were African American .  Time to first readmission or death was longer in intervention patients ( log rank chi(2)=5.0 , P=.026 ; Cox regression incidence density ratio=1.65 , 95 % confidence interval=1.13 - 2.40 ) . At 52 weeks , intervention group patients had fewer readmissions ( 104 vs 162 , P=.047 ) and lower mean total costs ( $ 7,636 vs $ 12,481 , P=.002 ) . For intervention patients , only short-term improvements were demonstrated in overall quality of life ( 12 weeks , P<.05 ) , physical dimension of quality of life ( 2 weeks , P<.01 ; 12 weeks , P<.05 ) and patient satisfaction ( assessed at 2 and 6 weeks , P<.001 ) . CONCLUSION A comprehensive transitional care intervention for elders hospitalized with heart failure increased the length of time between hospital discharge and readmission or death , reduced total number of rehospitalizations , and decreased healthcare costs , thus demonstrating great promise for improving clinical and economic outcomes Previous studies have found that home-based intervention programs reduce readmission rates for patients with heart failure . Only one previous trial has compared telephone and videophone to traditional care to deliver a home-based heart failure intervention program . The objective of this study was to evaluate the efficacy of a telehealth-facilitated postdischarge support program in reducing re source use in patients with heart failure . Patients at a Midwestern Department of Veterans Affairs Medical Center were r and omized to telephone , videophone , or usual care for follow-up care after hospitalization for heart failure exacerbation . Outcome measures included readmission rates ; time to first readmission ; urgent care clinic visits ; survival ; and quality of life . The intervention result ed in a significantly longer time to readmission but had no effect on readmission rates or mortality . There were no differences in hospital days or urgent care clinic use . All subjects reported higher disease-specific quality of life scores at 1 year . There was evidence of the value of telephone follow-up , but there was no evidence to support the benefit of videophone care over telephone care . Rigorous evaluation is needed to determine which patients may benefit most from specific telehealth applications and which technologies are most cost-effective Context Case management by nurses improves outcomes for patients with heart failure , but studies have targeted patients at high risk for poor outcomes because of sociodemographic or clinical factors . Whether such programs benefit low-risk patients with heart failure is unknown . Contribution Among 462 patients in 1 staff-model health maintenance organization who were hospitalized with heart failure , those r and omly assigned to nurse care management  had rates of rehospitalization and death similar to rates in those who received usual care . Implication s Care management for heart failure may offer limited benefit for patients with clinical and sociodemographic characteristics that put them at low risk for hospitalization or death . The Editors The societal and personal burden of heart failure is large and is growing apace with the aging of the population ( 1 ) . Heart failure is the largest Medicare expenditure and is the leading cause of hospitalization for persons 65 years of age or older ( 2 ) . Rates of hospital readmission within 6 months range from 25 % to 50 % ( 3 ) . Moreover , behavioral factors , such as nonadherence to diet and medications , and social factors , such as social isolation and indigence , frequently contribute to early rehospitalizations ( 3 - 4 ) . Previous studies of specialized treatment programs for heart failure have targeted clinical ly high-risk , medically underserved population s. These studies demonstrated reductions in rehospitalization for heart failure and , to a lesser extent , rehospitalization for all causes ( 4 - 6 ) . In a pilot study conducted at a single Kaiser Permanente medical center in 1994 to 1995 , we found a statistically significant reduction in rehospitalization rates during a 3-month period among low-risk patients with heart failure who received nurse care management over a 6-month period ( 7 ) . The present study evaluated nurse care management for heart failure in a low-risk population of patients selected from several medical centers in the same large health maintenance organization ( HMO ) . Methods Design This was a r and omized , controlled trial of a nurse care management system for heart failure . Patient Sample We selected patients who were hospitalized with a provisional diagnosis of heart failure from Kaiser Permanente medical centers located in San Francisco , Vallejo , Walnut Creek , Sacramento , and Roseville , California , between May 1998 and October 2000 .  Hospital-based project nurses review ed hospital charts to screen for patients with new-onset or worsening heart failure on the basis of 1 ) shortness of breath ( dyspnea at rest , including orthopnea or paroxysmal nocturnal dyspnea ) and 2 ) at least 1 corroborating clinical sign ( pulmonary congestion on examination , including rales , crackles , or wheezes ) or radiologic abnormality ( pulmonary congestion on chest radiograph ) consistent with heart failure . We excluded patients who were scheduled for coronary artery bypass or valvular surgery ; had undergone cardiac surgery in the preceding 8 weeks ; had a serum creatinine value of 13.26 mol/L ( 5 mg/dL ) or greater ; were receiving dialysis or awaiting renal transplantation ; had a history of severe pulmonary disease requiring home oxygen ; had 1 or more additional diseases that were expected to result in death within 1 year ; had cognitive mental deficits , substance abuse , or severe psychiatric disorders ; or were expected to move from the area within 1 year . We did not use measurements of left ventricular function by echocardiography , radionuclide angiography , or contrast angiography as selection criteria . Among the 59 % of patients who had left ventricular ejection fraction measured , 28 % had an ejection fraction less than 0.40 and 31 % had an ejection fraction of 0.40 or greater . Study nurses interviewed patients during hospitalization or by telephone within 2 weeks after discharge , explained the purpose of the study , and obtained written informed consent . Research staff who were not associated with delivering the intervention r and omly assigned patients to treatment conditions by using sealed assignments . Equal numbers of patients were allocated to the 2 groups in each medical center by using the Efron procedure ( 8) . Physicians were notified of r and omization assignment by letter . The institutional review boards at Stanford University and Kaiser Permanente approved the study . Baseline Data Collection Baseline data , recorded by staff nurses on st and ardized forms , included sociodemographic characteristics , self-reported illnesses , medications , and results of st and ard diagnostic studies and laboratory tests . Treatment Environment Before the study , the investigators met with the medical staffs of the 5 participating hospitals to present and discuss the research protocol , including detailed descriptions of the planned interactions between the nurse care managers and the medical staff . The medical staffs were multispecialty groups of 20 to 60 physiciansapproximately 480 physicians total . After r and omization , all patients continued to receive usual care , including instruction on diet , drug adherence , physical activity , and response to changing symptoms .  Intervention In addition to usual care , patients in the intervention group received a physician-directed , nurse-managed , home-based program for heart failure developed by the investigators ( 9 ) . Originally design ed for coronary risk factor management , this program was exp and ed to encompass heart failure . It incorporated the features of best practice design ated by Rich ( 10 ) : coordination of care across disciplines , patient and caregiver education , enhancement of self-management skills , effective follow-up , and guidelines -based medications for heart failure . Our system also incorporated the principles of heart failure management developed by the Cardiovascular Nursing Council of the American Heart Association ( 11 ) . The st and ardized , telephone-mediated intervention included the following elements : initial educational session , including a videotape ; baseline telephone counseling session ; nurse-initiated follow-up telephone contacts ; pharmacologic management ; and nurse-initiated communication with physicians . The initial 1-hour educational session with a nurse occurred in the patient 's medical center . Patients received printed educational material s , including methods for self-monitoring of symptoms , body weight , and medications ; a dietary management workbook ; food-frequency question naires ; and instructions on how to access emergency care in case symptoms abruptly worsened . Patients viewed a videotape portraying the treatment process . Two experienced Stanford-based nurse care managers provided a 45-minute baseline telephone counseling session within 1 week of r and omization ; subsequent nurse contacts were tailored to the needs of the individual patients . Nurse-initiated follow-up telephone contacts with patients during daytime weekday hours were scheduled at weekly intervals for 6 weeks ; biweekly for 8 weeks ; monthly for 3 months ; bimonthly for 6 months ; and as needed to monitor patients ' medications , laboratory assessment s , symptoms , and other medical problems . We based pharmacologic management for heart failure on published treatment guidelines ( 12 , 13 ) . The nurse care managers obtained permission from physicians to initiate and regulate pharmacologic therapy for heart failure according to study protocol . Nurse-initiated communication with physicians about patients ' current medical status was maintained and specific management problems were addressed . Nurse care managers spent an average of 9 hours per patient coordinating the treatment plan with patients and physicians during the first year . The intervention did not include consultation with social services to facilitate discharge planning or home visits after discharge . Measurement Research staff who were not associated with , and were blinded to , the intervention conditions measured health outcomes at 12 months . On the basis of review of the Kaiser Permanente medical records , project nurses used st and ardized forms to record the cause , number , and duration of hospitalizations and emergency department visits during the 12-month follow-up period . Kaiser Permanente provided more than 90 % of all care . Two cardiologists who were not associated with implementing the intervention review ed medical records on deaths , rehospitalizations , and emergency department visits to determine whether these events were primarily due to heart failure or due to other causes . They did not use discharge diagnoses recorded in the medical record to make these judgments . Rehospitalizations and emergency department visits were classified as either due to heart failure or due to other causes ; the latter were classified as cardiac or noncardiac . Outcomes The primary outcome of the study was the time to first rehospitalization for heart failure or for any cause . In our analysis , we treated deaths occurring before rehospitalization as censored data . However , analysis in which we classified deaths occurring before rehospitalization as outcome events result ed in similar conclusions , primarily because most observed deaths occurred after a rehospitalization . Secondary outcomes were the time to a composite outcome of death , rehospitalization , or emergency department visits for cardiac cause or for any cause , the proportion of patients receiving recommended pharmacotherapy , and the rate of outpatient clinic and emergency department visits . We based the study 's power on a proposed reduction in the risk for rehospitalization for heart failure from 21 % to 13 % , corresponding to a number needed to treat for benefit of 12.5 . We expected that the actual number needed to treat for benefit would be less than 12.5 . Statistical Analysis We evaluated the effect of care management on rehospitalization rates by using KaplanMeier survival curves and Cox proportional hazards regression models . We compared nominal variables by using chi-square tests , ordered variables by Background . The growing number of patients with congestive heart failure has increased both the pressure on hospital re sources and the need for community management of the condition . Improving hospital-to-home transition for this population is a logical step in responding to current practice guidelines ’ recommendations for coordination and education . Positive outcomes have been reported from trials evaluating multiple interventions , enhanced hospital discharge , and follow-up through the addition of a case management role . The question remains if similar gains could be achieved working with usual hospital and community nurses . Methods . A 12-week , prospect i ve , r and omized controlled trial was conducted of the effect of transitional care on health-related quality of life ( disease-specific and generic measures ) , rates of readmission , and emergency room use .  The nurse-led intervention focused on the transition from hospital-to-home and supportive care for self-management 2 weeks after hospital discharge . Results . At 6 weeks after hospital discharge , the overall Minnesota Living with Heart Failure Question naire ( MLHFQ ) score was better among the Transitional Care patients ( 27.2 ± 19.1 SD ) than among the Usual Care patients ( 37.5 ± 20.3 SD;P = 0.002 ) . Similar results were found at 12 weeks postdischarge for the overall MLHFQ and at 6- and 12-weeks postdischarge for the MLHFQ ’s Physical Dimension and Emotional Dimension subscales . Differences in generic quality life , as assessed by the SF-36 Physical component , Mental Component , and General Health subscales , were not significantly different between the Transition and Usual Care groups . At 12 weeks postdischarge , 31 % of the Usual Care patients had been readmitted compared with 23 % of the Transitional Care patients ( P = 0.26 ) , and 46 % of the Usual Care group visited the emergency department compared with 29 % in the Transitional Care group ( & khgr;2 = 4.86 , df 1 , P = 0.03 ) . Conclusions . There were significant improvements in health-related quality of life ( HRQL ) associated with Transitional Care and less use of emergency rooms BACKGROUND One approach to optimize clinical and economic management of congestive heart failure is the use of multidisciplinary outpatient clinics in which advanced practice nurses coordinate care . One such clinic was developed in 1995 at a southeastern university hospital to enhance management of patients with chronic congestive heart failure . OBJECTIVES To evaluate the effects of a multidisciplinary outpatient heart failure clinic on the clinical and economic management of patients with congestive heart failure . METHODS Data on hospital readmissions , emergency department visits , length of stay , charges , and reimbursement from the 6 months before 15 patients joined a heart failure clinic  were compared with data from the 6 months after the patients joined the clinic . RESULTS The patients had a total of 38 hospital admissions ( 151 hospital days ) in the 6 months before joining the clinic and 19 admissions ( 72 hospital days ) in the 6 months afterward . The mean length of stay decreased from 4.3 days in the 6 months before joining to 3.8 days in the 6 months afterward , and the number of emergency department visits also decreased , although neither decrease was statistically significant . Mean inpatient hospital charges decreased from $ 10,624 per patient admission to $ 5893 . Reimbursements were $ 7751 ( 73 % collection rate ) and $ 5138 ( 87 % collection rate ) , respectively . CONCLUSIONS Patients seemed to benefit from participation in the heart failure clinic . If a healthcare provider is available to manage early signs and symptoms of worsening heart failure , hospital readmissions may be decreased and patients ' outcomes may be improved Aim : Quality of life ( QOL ) can be considered as a quality indicator of health care systems and nurses can play an important role to improve QOL in patients with congestive heart failure ( CHF ) . The aim of this study was to determine the effects of education provided by nurses on the QOL in patients with CHF in home-visit care compared to usual care . Method : In a single-blind r and omized controlled trial conducted from September 2011 to June 2012 , 110 patients with CHF were r and omly assigned into two groups . While patients in group I were received usual education at the time of hospital discharge , patients in Group II , in addition to usual education , were received special education regards to their illness by nurses who visited patients in their homes . The 36-item short-form ( SF-36 ) question naire was used to evaluate the patient ’s QOL at the time of discharge and also six months after hospital discharge . Results : At the time of hospital discharge , mean score of all 8 sub-score of SF-36 question naire was 63.4±7.8 in patients of group II and 61.1±6.4 in patients of group I , respectively ( P > 0.05 ) . QOL was decreased in group I and increased in group II compared to the time of hospital discharge . After six months , mean score of QOL was higher in group II than in group I. Conclusions : QOL of patients with CHF were decreased after hospital discharge . Education provided by nurses in home-visit care could improve the QOL in patients with CHF , based on the findings of this study The aim of this study was to determine whether home telehealth , when integrated with the health facility 's electronic medical record system , reduces healthcare costs and improves quality -of-life outcomes relative to usual home healthcare services for elderly high re source users with complex co-morbidities . Study patients were identified through the medical center 's data base . Intervention patients received home telehealth units that used st and ard phone lines to communicate with the hospital . FDA -approved peripheral devices monitored vital signs and valid question naires were used to evaluate quality -of-life outcomes . Out-of-range data triggered electronic alerts to nurse case managers . ( No live video or audio was incorporated in either direction . ) Templated progress notes facilitated seamless data entry into the patient 's electronic medical record . Participants ( n = 104 ) with complex heart failure , chronic lung disease , and /or diabetes mellitus were r and omly assigned to an intervention or control group for 6 - 12 months . Parametric and nonparametric analyses were performed to compare outcomes for ( 1 ) subjective and objective quality -of-life measures , ( 2 ) health re source use , and ( 3 ) costs . In contrast to the control group , scores for home telehealth subjects showed a statistically significant decrease at 6 months for bed-days-of-care ( p < 0.0001 ) , urgent clinic/emergency room visits ( p = 0.023 ) , and A1C levels ( p < 0.0001 ) ; at 12 months for cognitive status ( p < 0.028 ) ; and at 3 months for patient satisfaction ( p < 0.001 ) . Functional levels and patient-rated health status did not show a significant difference for either group . Integrating home telehealth with the healthcare institution 's electronic data base significantly reduces re source use and improves cognitive status , treatment compliance , and stability of chronic disease for homebound elderly with common complex co-morbidities INTRODUCTION AND OBJECTIVES Home-based interventions after hospital discharge in patients with heart failure ( HF ) have been shown to decrease readmission and mortality rates . The primary aim of this study was to determine the effect of a home-based educational intervention carried out by nursing staff on the readmission rate , emergency department visits , and healthcare costs . PATIENTS AND METHOD Patients hospitalized with systolic HF were r and omly assigned to receive either usual care or a single home-based educational intervention 1 week after discharge . RESULTS Between July 2001 and November 2002 , 70 patients entered the study : 34 in the intervention group and 36 in the control group . During the 6-month follow-up , there were fewer unplanned readmissions in the intervention group than in the control group ( 0.09 vs 0.94 ; P<.001 ) , fewer emergency department visits ( 0.21 vs 1.33 ; P<.001 ) , and fewer out-of-hospital deaths ( 2 vs 11 ; P<.01 ) . Costs were also significantly lower in the intervention group ( difference , ; 1190.9 ; P<.001 ) . Moreover , patient-perceived health status , as indicated by scores on a quality -of-life question naire , increased significantly in the intervention group . CONCLUSIONS In a cohort of patients with systolic HF who received a home-based educational intervention there were significant reductions in the unplanned readmission rate , mortality , and healthcare costs , and better quality of life . Some limitations of the study warrant validation of the result ats in further studies OBJECTIVE The objective of the study was to evaluate the effectiveness of a single home-based educational intervention for patients admitted with heart failure . METHODS There were 106 patients : 42 in the intervention group and 64 in the control group . Patients were r and omly assigned to receive an intervention by nursing staff 1 week after discharge . Primary end points were readmissions , emergency department visits , deaths , costs , and quality of life . RESULTS During the 24-month follow-up , there were fewer mean emergency department visits in the intervention group than in the control group ( .68 vs 2.00 ; P = .000 ) , fewer unplanned readmissions ( .68 vs 1.71 ; P = .000 ) , and lower costs ( € 671.56 = $ 974.63 = GBP598.42 per person vs € 2,154.24 = $ 3,126.01 = GBP1,919.64 ; P = .001 ) . There was a trend toward fewer out-of-hospital deaths ( 14 [ 46.6 % ] vs 31 [ 55.3 % ] ; P = .45 ) and improvement in quality of life . CONCLUSION Patients with heart failure who receive a home-based educational intervention  experience fewer emergency department visits and unplanned readmissions with lower healthcare costs BACKGROUND Patients with heart failure ( HF ) face challenges complying with multidrug regimens . OBJECTIVES To examine the impact of a compliance enhancing intervention on medication compliance and morbidity in HF . DESIGN Patients were r and omized to either usual care or an inhospital educational intervention  delivered by a multidisciplinary team ( Intervention ) . SETTING Acute medical and surgical units at a teaching hospital . PATIENTS One hundred thirty four patients with a clinical diagnosis of HF and a left ventricular ejection fraction of < 40 % requiring long-term medical treatment . MAIN OUTCOME MEASURES A vali date d HF-specific instrument provided a measure of knowledge . We characterized patients as noncompliant if pharmacy refill data suggested they had taken < or = 0.80 of their medication . We measured quality of life using the Minnesota Living with Heart Failure Question naire and the Short Form 36 and conducted a time to first event analysis of a composite end point including mortality , readmissions , and emergency department visits . RESULTS The Intervention group showed higher knowledge scores at discharge and 1 year ( P = .05 ) . The risk of noncompliance in Intervention patients varied from 0.78 ( 95 % CI 0.33 - 1.89 ) for ACE-I ( 13 % Intervention , 17 % Control ) to 1.02 ( 0.49 - 2.12 ) for diuretics ( 23 % Intervention , 23 % Control ) . Quality of life improved in both groups over time ; the only difference between groups favored the Intervention ( Minnesota Living with Heart Failure Question naire , P = .04 ) . The composite end point occurred in 67 % of control and 60 % of Intervention patients ( hazard ratio 0.85 , 95 % CI 0.55 - 1.30 ) . CONCLUSIONS An inhospital educational intervention improved knowledge and , possibly , quality of life and may be useful as part of a comprehensive compliance enhancing strategy in patients with HF AIMS Heart failure chiefly affects the elderly , with frequent emergency admissions . Telemonitoring can identify worsening heart failure but previous r and omized trials have enrolled selected patient population s. The Home-HF study examined the impact of home telemonitoring on typical heart failure patients discharged from three acute hospitals in North West London , UK . METHODS AND RESULTS Patients hospitalized with heart failure were r and omized to telemonitoring or usual specialist care . Primary outcome measures were days alive and out of hospital . Secondary outcome measures were number and duration of heart failure hospitalizations , clinic visits , and quality of life .  We recruited 182 patients . There was no difference in the primary outcome measure in the two groups , but there were significantly fewer unplanned hospitalizations for heart failure decompensation , and a reduction in clinic and emergency room visits in the telemonitoring group . There was no statistically significant difference in the mean direct health service costs . CONCLUSION Home telemonitoring in a typical elderly population of heart failure patients produces a similar outcome to ' usual ' specialist care , but reduces clinic and emergency room visits and unplanned heart failure rehospitalizations at little additional cost . This method of disease monitoring may allow specialist services to increase the number of patients under their care BACKGROUND This study was conducted to investigate the effects of family training and support on quality of life and cost of hospital readmissions in congestive heart failure patients . METHODS In this single-blinded , r and omized , controlled trial , the participants were heart failure patients hospitalized in an Iranian hospital . Data were collected from available hospitalized patients . The participants were enrolled through r and omized sampling and were divided r and omly into two groups , an intervention group and a control group . The intervention group received extra training package for the disease . Training was provided at discharge and three months after . A st and ard question naire to assess the QoL was filled out by both groups at discharge and six months after . RESULTS Mean scores of QoL domains at the beginning of the study decreased in control group and increased in intervention in comparison with six months after ( p<0.01 ) . CONCLUSION Nursing care follow-up according to heart failure patients ' needs promoted their BACKGROUND Telemonitoring has been advocated as a way of decreasing costs and improving outcomes , but no study has looked at true Medicare payments and 30-day readmission rates in a r and omized group of well treated patients . OBJECTIVE The aim of this work was to analyze Medicare cl aims data to identify effects of home telemonitoring on medical costs , 30-day rehospitalization , mortality , and health-related quality of life . METHODS A total of 204 subjects were r and omized to usual-care and monitored groups and evaluated with the SF-36 and Minnesota Living With Heart Failure Question naire ( MLHF ) . Hospitalizations , Medicare payments , and mortality were also assessed . Monitored subjects transmitted weight , blood pressure , and heart rate , which were monitored by an experienced heart failure nurse practitioner . RESULTS Subjects were followed for 802 ± 430 days ; 75 subjects in the usual-care group ( 316 hospitalizations ) and 81 in the monitored group ( 327 hospitalizations ) were hospitalized at least once ( P = .51 ) . There were no differences in Medicare payments for inpatient or emergency department visits , and length of stay was not different between groups . There was no difference in 30-day readmissions ( P = .627 ) or mortality ( P = .575 ) . Scores for SF-36 and MLHF improved ( P < .001 ) over time , but there were no differences between groups . The percentage of patients readmitted within 30 days was lower with telemonitoring for the 1st year , but this did not persist . CONCLUSIONS Telemonitoring did not result in lower total costs , decreased hospitalizations , improved symptoms , or improved mortality . A decrease in 30-day readmission rates for the 1st year did not result in decreased total cost or better outcomes OBJECTIVES To evaluate the effect of an exercise-based model of hospital and in-home follow-up care for older people at risk of hospital readmission on emergency health service utilization and quality of life . DESIGN R and omized controlled trial . SETTING Tertiary metropolitan hospital in Australia . PARTICIPANTS One hundred twenty-eight patients ( 64 intervention , 64 control ) with an acute medical admission , aged 65 and older and with at least one risk factor for readmission ( multiple comorbidities , impaired functionality , aged > or=75 , recent multiple admissions , poor social support , history of depression ) . INTERVENTION Comprehensive nursing and physiotherapy assessment and individualized program of exercise strategies and nurse-conducted home visit and telephone follow-up commencing in the hospital and continuing for 24 weeks after discharge . MEASUREMENTS Emergency health service utilization ( emergency hospital readmissions and visits to emergency department , general practitioner ( GP ) , or allied health professional ) and health-related quality of life ( Medical Outcomes Study 12-item Short Form Survey ( SF-12v2 ) collected at baseline and 4 , 12 , and 24 weeks after discharge . RESULTS The intervention group required significantly fewer emergency hospital readmissions ( 22 % of intervention group , 47 % of control group , P=.007 ) and emergency GP visits ( 25 % of intervention group , 67 % of control group , P<.001 ) . The intervention group also reported significantly greater improvements in quality of life than the control group as measured using SF-12v2 Physical Component Summary scores ( F ( 3 , 279)=30.43 , P<.001 ) and Mental Component Summary scores ( F ( 3 , 279)=7.20 , P<.001 ) . CONCLUSION Early introduction of an individualized exercise program and long-term telephone follow-up may reduce emergency health service utilization and improve quality of life of older adults at risk of hospital readmission Aim of the study was to evaluate mortality and functional , cognitive , affective status in elderly patients ( > or=75 years ) with exacerbation of chronic obstructive pulmonary disease ( COPD ) or acute congestive heart failure ( CHF ) admitted to the emergency department ( ED ) of S. Giovanni Battista Hospital of Torino and r and omly assigned to the geriatric home hospitalization service ( GHHS ) or to a general medical ward ( GMW ) . All patients were evaluated on admission , on discharge and at 6 months , using a st and ardized study protocol . We excluded patients with unstable medical conditions . The total sample included 73 patients : 35 with COPD exacerbation ( 19 GHHS , 16 GMW ) and 38 with CHF ( 19 GHHS , 19 GMW ) . Mean age was 81.7+/-8.0 years . At baseline , no significant differences in demographic , social and clinical conditions were found between the two groups of patients . 56.7 % of COPD patients had a severe exacerbation , according to Anthonisen criteria ; 65 % of CHF patients were NYHA-III and 35 % NYHA-IV ( according to the criteria of the New York Heart Association ) ( FE<35 % in 40 % of patients ) . On admission all patients were partially dependent in ADLs and IADLs , with a moderate impairment of depression score and a fairly good quality of life . On discharge depression score and quality of life were significantly better only in GHHS patients . Mortality was similar in the two setting of care . Patients managed at home had a significantly longer length of treatment . At 6-month follow-up we did not observe a difference in mortality , but we observed a higher readmission rate in patients previously treated in hospital . In conclusion , our study indicates that home-treated patients with COPD or CHF have better depressive scores and quality of life and a lower rate of hospital readmission after six months OBJECTIVE To evaluate the effectiveness of a Transcendental Meditation ( TM ) stress reduction program for African Americans with congestive heart failure ( CHF ) . DESIGN R and omized , controlled study PARTICIPANTS AND INTERVENTION We recruited 23 African American patients > or = 55 years of age who were recently hospitalized with New York Heart Association class II or III CHF and with an ejection fraction of < .40 . Participants were r and omized to either TM or health education ( HE ) group . MAIN OUTCOME MEASURES Primary outcome measure was six-minute walk test ; secondary outcomes were generic and disease-specific health-related quality of life , quality of well being , perceived stress , Center for Epidemiologic Studies Depression Scale ( CES-D ) , rehospitalizations , brain natriuretic peptide , and cortisol . Changes in outcomes from baseline to three and six months after treatment were analyzed by using repeated measures analysis of variance , covarying for baseline score . RESULTS For the primary outcome of functional capacity , the TM group significantly improved on the six-minute walk test from baseline to six months after treatment compared to the HE group ( P = .034 ) . On the secondary outcome measures , the TM group showed improvements in SF-36 subscales and total score on the Minnesota Living with Heart Failure scale . On the CES-D , the TM group showed significant decrease from baseline to six months compared to the HE group ( P = .03 ) . Also , the TM group had fewer rehospitalizations during the six months of followup . CONCLUSIONS Results indicate that TM can be effective in improving the quality of life and functional capacity of African American CHF patients . Further validation of outcomes is planned via a large , multicenter trial with long-term follow-up The aim of the study was to evaluate , in a controlled setting , the effects of a 5-month dynamic peripheral training programme in patients with clinical signs of congestive heart failure with special reference to their anaerobic threshold , muscle function , heart rate variability and quality of life . Twenty-four r and omized patients with clinical signs of heart failure in NYHA II-III entered the study . Training result ed in a significant ( p = 0.01 ) change in the anaerobic threshold , the patients ' ability to lift weights ( p = 0.01 ) and performance of heel-lift ( p = 0.01 ) . The heart rate recorded during the training exercises decreased significantly ( p = 0.04 ) . There were no significant differences in peak oxygen uptake , isokinetic and isometric strength , HRV and quality of life except for three items in the control group . The results of this study indicate that peripheral training is beneficial for patients with clinical signs of congestive heart failure OBJECTIVE Published data supporting the best practice for patients with atrial fibrillation ( AF ) presenting to the emergency department ( ED ) are limited . Our objective was to evaluate the impact of an AF clinical protocol initiated in the ED with early follow-up in a specialty AF outpatient clinic . METHODS This was a single-center prospect i ve study of all consented patients with AF who were discharged from the ED through the AF clinical pathway and were then  seen in the AF clinic . The primary endpoint was the rate of 90-day hospitalization/ED visits . Secondary endpoints included adherence to established AF anticoagulation guidelines , rate of thromboembolic events , quality of life , and patient satisfaction . RESULTS One hundred consecutive patients were enrolled in the study . Within 90 days , 15 had ED visits and 4 were hospitalized , whereas none developed thromboembolic complications . There were significant increases in the Atrial Fibrillation Effect on QualiTy of life survey quality of life ( 67.3 ± 24.8 vs. 89.2 ± 15.7 ; P < 0.001 ) and patient satisfaction ( 66.4 ± 25.3 vs. 77.9 ± 22.8 ; P < 0.001 ) scores from baseline to 90 days . Of the 29 patients with CHADS2 score ≥2 , 20 ( 69 % ) were discharged from the AF clinic with oral anticoagulation . CONCLUSIONS We describe a novel approach to the care of patients with AF presenting to the ED . Usage of the ED-initiated AF clinical pathway with early follow-up in a protocol -driven AF clinic was associated with low readmission rates , no thromboembolic complications at 90 days , improved quality of life , and high patient satisfaction
The effective management of patients with congestive heart failure in long term home care setting s is important in reducing rehospitalization , emergency department visits and improving quality of life .
Congestive heart failure results in clinical signs of edema , shortness of breath , and decreased quality of life .
Telehealth interventions following hospital discharge in various setting s have been reported in the published literature as having an impact on decreasing emergency department visits , rehospitalization and quality of life .