Main Findings : The results indicate that an intervention involving any human factor principles may nearly double an individual ’s probability of not being readmitted .
Principal Conclusions : Interventions with human factor principles reduce readmissions among HF patients .
Background : Human factors play an important role in health-care outcomes of heart failure ( HF ) patients .
A systematic review and meta- analysis of clinical trial studies on HF hospitalization may yield positive proofs of the beneficial effect of specific care management strategies .
Purpose : To investigate how the 8 guiding principles of choice , rest , environment , activity , trust , interpersonal relationships , outlook , and nutrition reduce HF readmissions .
Prolonged impact of home versus clinic-based management of chronic heart failure: extended follow-up of a pragmatic, multicentre randomized trial cohort.
OBJECTIVES We compared the longer-term impact of the two most commonly applied forms of post-discharge management design ed to minimize recurrent hospitalization and prolong survival in typically older patients with chronic heart failure ( CHF ) . METHODS We followed a multi-center r and omized controlled trial cohort of Australian patients hospitalized with CHF and initially allocated to home-based or specialized CHF clinic-based intervention for 1368 ± 216 days . Blinded endpoints included event-free survival from all-cause emergency hospitalization or death , all-cause mortality and rate of all-cause hospitalization and stay . RESULTS 280 patients ( 73 % male , aged 71 ± 14 years and 73 % left ventricular systolic dysfunction ) were initially r and omized to home-based ( n=143 ) or clinic-based ( n=137 ) intervention . During extended follow-up ( complete for 274 patients ) , 1139 all-cause hospitalizations ( 7477 days of hospital stay ) and 121 ( 43.2 % ) deaths occurred . There was no difference in the primary endpoint ; 20 ( 14.0 % ) home-based versus 13 ( 7.4 % ) clinic-based patients remained event-free ( adjusted HR 0.89 , 95 % CI 0.70 to 1.15 ; p=0.378 ) . Significantly fewer home-based ( 51/143 , 35.7 % ) than clinic-based intervention ( 71/137 , 51.8 % ) patients died ( adjusted HR 0.62 , 95 % CI 0.42 to 0.90 : p=0.012 ) . Home-based versus clinic-based intervention patients accumulated 592 and 547 all-cause hospitalizations ( p=0.087 ) associated with 3067 ( median 4.0 , IQR 2.0 to 6.8 ) versus 4410 ( 6.0 , IQR 3.0 to 12.0 ) days of hospital stay ( p<0.01 for rate and duration of hospital stay ) . CONCLUSIONS Relative to clinic-based intervention , home-based intervention was not associated with prolonged event-free survival  . Home-based intervention was , however , associated with significantly fewer all-cause deaths and significantly fewer days of hospital stay in the longer-term . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry number 12607000069459 ( http://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=81803 )
Main Findings : The results indicate that an intervention involving any human factor principles may nearly double an individual ’s probability of not being readmitted .
Principal Conclusions : Interventions with human factor principles reduce readmissions among HF patients .
Background : Human factors play an important role in health-care outcomes of heart failure ( HF ) patients .
A systematic review and meta- analysis of clinical trial studies on HF hospitalization may yield positive proofs of the beneficial effect of specific care management strategies .
Purpose : To investigate how the 8 guiding principles of choice , rest , environment , activity , trust , interpersonal relationships , outlook , and nutrition reduce HF readmissions .