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 .
Impact of home versus clinic-based management of chronic heart failure: the WHICH? (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care) multicenter, randomized trial.
OBJECTIVES The goal of this study was to make a head-to-head comparison of 2 common forms of multidisciplinary chronic heart failure ( CHF ) management . BACKGROUND Although direct patient contact appears to be best in delivering CHF management overall , the precise form to optimize health outcomes is less clear . METHODS This prospect i ve , multicenter r and omized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients ( 73 % male , age 71 ± 14 years , and 73 % with left ventricular ejection fraction ≤45 % ) r and omized to home-based intervention ( HBI ) or specialized CHF clinic-based intervention ( CBI )  . The primary endpoint was all-cause , unplanned hospitalization or death during 12- to 18-month follow-up . Secondary endpoints included type/ duration of hospitalization and healthcare costs . RESULTS The primary endpoint occurred in 102 of 143 ( 71 % ) HBI versus 104 of 137 ( 76 % ) CBI patients ( adjusted hazard ratio [ HR ] : 0.97 [ 95 % confidence interval ( CI ) : 0.73 to 1.30 ] , p = 0.861 ) : 96 ( 67.1 % ) HBI versus 95 ( 69.3 % ) CBI patients had an unplanned hospitalization ( p = 0.887 ) , and 31 ( 21.7 % ) versus 38 ( 27.7 % ) died ( p = 0.252 ) . The median duration of each unplanned hospitalization was significantly less in the HBI group ( 4.0 [ interquartile range ( IQR ) : 2.0 to 7.0 ] days vs. 6.0 [ IQR : 3.5 to 13 ] days ; p = 0.004 ) . Overall , 75 % of all hospitalization was attributable to 64 ( 22.9 % ) patients , of whom 43 ( 67 % ) were CBI patients ( adjusted odds ratio : 2.55 [ 95 % CI : 1.37 to 4.73 ] , p = 0.003 ) . HBI was associated with significantly fewer days of all-cause hospitalization ( -35 % ; p = 0.003 ) and from cardiovascular causes ( -37 % ; p = 0.025 ) but not for CHF ( -24 % ; p = 0.218 ) . Consequently , healthcare costs ( $ AU3.93 vs. $ AU5.53 million ) were significantly less for the HBI group ( median : $ AU34 [ IQR : 13 to 81 ] per day vs. $ AU52 [ 17 to 140 ] per day ; p = 0.030 ) . CONCLUSIONS HBI was not superior to CBI in reducing all-cause death or hospitalization .  However , HBI was associated with significantly lower healthcare costs , attributable to fewer days of hospitalization . ( Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care [ WHICH ? ] ; ACTRN12607000069459 )
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 .