evidenced based nursing

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Evidenced Based Practice:Innovations/Discoveries inthe Management ofCardiovascular Disorders Elrey Joseph Calitis R.N.Maeanjneth Cuaton R.N.


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Evidenced Based Practice

Article: Discharge Education ImprovesClinical Outcomes in Patients WithChronic Heart Failure

Published: January 2005


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Background

Heart failure is the most common cause ofhospitalization among adults over 65. Over 60%of patients die within 10 years of first onset of

symptoms. Although interventions combiningpatient education and post-dischargemanagement have demonstrated benefits inpatients with chronic heart failure, the benefitattributable to patient education alone is notknown. We hypothesized that a patientdischarge education program would improveclinical outcomes in patients with chronic heartfailure.


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Methodology

METHODOLOGY

A.Ethical ConsiderationB. The ParticipantsC. InterventionsD.Purpose of the StudyE. Outcome MeasuresF. Statistical Method


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Ethical Consideration

The study was performed at University ofMichigan Hospital. The study wasapproved by the Medical SchoolInstitutional ReviewBoard( http://www.med.umich.edu/irbmed/ ).
http://www.med.umich.edu/irbmed/http://www.med.umich.edu/irbmed/http://www.med.umich.edu/irbmed/http://www.med.umich.edu/irbmed/


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The Participants

Study subjects were recruited from theinpatient services of the hospital fromApril 2001 through October 2002.Candidates for this study were admittedto the hospital with a diagnosis of heartfailure and documented left ventricular systolic dysfunction


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The Participants - Selection


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Interventions

Informed consent was obtained prior tothe study.Treatment assignment was concealed

from the patients and study personneluntil after the randomization step. Thecare providers for the patient in thehospital and in the outpatient arenawere not informed of the treatmentassignment.


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Interventions

Standard written discharge informationwas delivered in a folder by the assignedward nurse at the time of discharge.As part of usual care, it is likely thatpatients received additional teachingfrom resident and staff physicians, nurses,

and dietitians, although this could not becontrolled or quantified. Follow-up after hospital discharge was left to thediscretion of the inpatient medical team.


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Interventions

The patient education program includeda 60-minute-long, one-on-one teachingsession with a nurse educator beforedischarge. The nurse educator discussedheart failure specific information thatcovered the basic principles of thecauses of heart failure and rationale for pharmaceutical therapies.


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Purpose of the Study

To determine the whether dischargeeducation improves clinical

outcomes of patients with chronicheart failure.


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Outcome Measures

Scripted QuestionnairesSoftware


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Statistical Method

All analyses were performed withSPSS version 10.0 statistical software.


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Results: BaselineCharacteristics


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Results


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Results


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Results


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Results


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Results


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Results


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Results

Baseline MLHF scores for control (5922) andeducation (5623) subjects were similar. At the 30-day follow-up time point, MLHF scores were lower (i.e., improved) in the education group (3822)compared with the control group (4525, P =0.049).There was no difference in MLHF scores at the 180-day follow-up period between control (4225) andeducation (4122) subjects. Changes in MLHF scoresfrom baseline to the 30-day follow-up period weresignificant for both control and education subjects.Changes in MLHF from baseline in control andeducation subjects at 30-day follow-up (1521 versus1825, P =NS) and at 180-day follow-up (1824 versus

1323,P

=NS) did not differ.


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Results

The average cost for hospital readmission duringthe 180-day follow-up period was $829211 299 for control subjects versus $53699096 for education

subjects (P=0.034). The cost of the intervention isestimated to be $100 per subject (2 hours ofnursing time at $50 per hour). As a result, theoverall cost of care was higher in the controlgroup by $2823 (95% CI, $202 to $5644; P=0.035)per subject.


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Discussion

Our results show that a patient-targeted heart failureeducation program delivered at hospital dischargeleads to a reduction in the number of dayshospitalized or dead in a 180-day follow-up period.The combined end point of re-hospitalization or deathwas reduced in the patients exposed to the educationintervention by 35% compared with controls. Thiscombined end point was influenced largely by a 51%reduction in the need to be re-hospitalized due toheart failure. This is the first demonstration that patient-targeted education delivered at the time of dischargeleads to improved clinical outcomes in patients with

systolic heart failure.


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Limitations

1. Generality of the results.2. Absence of blinding of the nurse

coordinator to the treatmentassignment of the patients.3. Lack of reliability of self-reported

self-care measures.


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Conclusion

In this study, patients hospitalized for the treatmentof heart failure who received targeted patienteducation delivered by a nurse educator were lesslikely to be re-hospitalized during a 180-day follow-up period. Patients exposed to the educationprogram were also more likely to report appropriate,disease-specific, self-care practices. These improvedoutcomes were achieved at a substantial andsignificant reduction in costs. This is the first study todemonstrate the clinical benefit of a heart failurepatient education program restricted to the hospitaldischarge time period. Patient education should beincluded in the optimal care of patients suffering

from heart failure.


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APPRAISE AND CRITIQUE

Research Design

Level of Evidence (USPSTF) Level of Recommendation (USPSTF) Significance of the Study


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Research Design

Randomized controlled clinical trials Planned projects that study the effect ofa therapy on real patients. They includemethodologies that reduce the potentialfor bias (randomization and blinding) andthat allow for comparison betweenintervention groups and control groups(no intervention).


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Level of Evidence (USPSTF)

Level I Evidence obtained from at least oneproperly designed randomized controlledtrial


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Level of Recommendation(USPSTF)

Level AThe USPSTF recommends the

service. There is high certainty thatthe net benefit is substantial. Offer or provide this service.


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Significance of the Study

Providing comprehensive discharge educationto patients with heart failure is essential toimproving outcomes, and cardiac nurses are ina position to take on the role of educators.Patients with heart failure should understandtheir condition, their medications, and when toseek medical treatment. As more is learnedabout the important effects of education andself- care on patients outcomes, the need tomove away from the traditional view of patientsas passive recipients of information is clear.Patients should be viewed as active partners in

the management of their health.


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THANK YOU AND GODBLESS!

BE AN INSPIRATION TO ALL!

evidenced based nursing

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