scholarly journals Outcomes of a Heart Failure Telemonitoring Program Implemented as the Standard of Care in an Outpatient Heart Function Clinic: Pretest-Posttest Pragmatic Study

10.2196/16538 ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. e16538 ◽  
Author(s):  
Patrick Ware ◽  
Heather J Ross ◽  
Joseph A Cafazzo ◽  
Chris Boodoo ◽  
Mikayla Munnery ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Service ◽  
Clinical Outcomes ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Heart Function ◽  
Self Care ◽  
Standard Of Care ◽  
Program Enrollment ◽  
Secondary Outcomes

Background Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decisions. The Medly program enables patients to use a mobile phone to record daily HF readings and receive personalized self-care messages generated by a clinically validated algorithm. The TM system also generates alerts, which are immediately acted upon by the patients’ existing care team. This program has been operating for 3 years as part of the standard of care in an outpatient heart function clinic in Toronto, Canada. Objective This study aimed to evaluate the 6-month impact of this TM program on health service utilization, clinical outcomes, quality of life (QoL), and patient self-care. Methods This pragmatic quality improvement study employed a pretest-posttest design to compare 6-month outcome measures with those at program enrollment. The primary outcome was the number of HF-related hospitalizations. Secondary outcomes included all-cause hospitalizations, emergency department visits (HF related and all cause), length of stay (HF related and all cause), and visits to the outpatient clinic. Clinical outcomes included bloodwork (B-type natriuretic peptide [BNP], creatinine, and sodium), left ventricular ejection fraction, and predicted survival score using the Seattle Heart Failure Model. QoL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 5-level EuroQol 5-dimensional questionnaire. Self-care was measured using the Self-Care of Heart Failure Index (SCHFI). The difference in outcome scores was analyzed using negative binomial distribution and Poisson regressions for the health service utilization outcomes and linear regressions for all other outcomes to control for key demographic and clinical variables. Results Available data for 315 patients enrolled in the TM program between August 2016 and January 2019 were analyzed. A 50% decrease in HF-related hospitalizations (incidence rate ratio [IRR]=0.50; P<.001) and a 24% decrease in the number of all-cause hospitalizations (IRR=0.76; P=.02) were found when comparing the number of events 6 months after program enrollment with the number of events 6 months before enrollment. With regard to clinical outcomes at 6 months, a 59% decrease in BNP values was found after adjusting for control variables. Moreover, 6-month MLHFQ total scores were 9.8 points lower than baseline scores (P<.001), representing a clinically meaningful improvement in HF-related QoL. Similarly, the MLHFQ physical and emotional subscales showed a decrease of 5.4 points (P<.001) and 1.5 points (P=.04), respectively. Finally, patient self-care after 6 months improved as demonstrated by a 7.8-point (P<.001) and 8.5-point (P=.01) increase in the SCHFI maintenance and management scores, respectively. No significant changes were observed in the remaining secondary outcomes. Conclusions This study suggests that an HF TM program, which provides patients with self-care support and active monitoring by their existing care team, can reduce health service utilization and improve clinical, QoL, and patient self-care outcomes.

scholarly journals Outcomes of a Heart Failure Telemonitoring Program Implemented as the Standard of Care in an Outpatient Heart Function Clinic: Pretest-Posttest Pragmatic Study (Preprint)

2019 ◽  
Author(s):  
Patrick Ware ◽  
Heather J Ross ◽  
Joseph A Cafazzo ◽  
Chris Boodoo ◽  
Mikayla Munnery ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Service ◽  
Clinical Outcomes ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Heart Function ◽  
Self Care ◽  
Standard Of Care ◽  
Program Enrollment ◽  
Secondary Outcomes

BACKGROUND Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decisions. The <i>Medly</i> program enables patients to use a mobile phone to record daily HF readings and receive personalized self-care messages generated by a clinically validated algorithm. The TM system also generates alerts, which are immediately acted upon by the patients’ existing care team. This program has been operating for 3 years as part of the standard of care in an outpatient heart function clinic in Toronto, Canada. OBJECTIVE This study aimed to evaluate the 6-month impact of this TM program on health service utilization, clinical outcomes, quality of life (QoL), and patient self-care. METHODS This pragmatic quality improvement study employed a pretest-posttest design to compare 6-month outcome measures with those at program enrollment. The primary outcome was the number of HF-related hospitalizations. Secondary outcomes included all-cause hospitalizations, emergency department visits (HF related and all cause), length of stay (HF related and all cause), and visits to the outpatient clinic. Clinical outcomes included bloodwork (B-type natriuretic peptide [BNP], creatinine, and sodium), left ventricular ejection fraction, and predicted survival score using the Seattle Heart Failure Model. QoL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 5-level EuroQol 5-dimensional questionnaire. Self-care was measured using the Self-Care of Heart Failure Index (SCHFI). The difference in outcome scores was analyzed using negative binomial distribution and Poisson regressions for the health service utilization outcomes and linear regressions for all other outcomes to control for key demographic and clinical variables. RESULTS Available data for 315 patients enrolled in the TM program between August 2016 and January 2019 were analyzed. A 50% decrease in HF-related hospitalizations (incidence rate ratio [IRR]=0.50; <i>P</i>&lt;.001) and a 24% decrease in the number of all-cause hospitalizations (IRR=0.76; <i>P</i>=.02) were found when comparing the number of events 6 months after program enrollment with the number of events 6 months before enrollment. With regard to clinical outcomes at 6 months, a 59% decrease in BNP values was found after adjusting for control variables. Moreover, 6-month MLHFQ total scores were 9.8 points lower than baseline scores (<i>P</i>&lt;.001), representing a clinically meaningful improvement in HF-related QoL. Similarly, the MLHFQ physical and emotional subscales showed a decrease of 5.4 points (<i>P</i>&lt;.001) and 1.5 points (<i>P</i>=.04), respectively. Finally, patient self-care after 6 months improved as demonstrated by a 7.8-point (<i>P</i>&lt;.001) and 8.5-point (<i>P</i>=.01) increase in the SCHFI maintenance and management scores, respectively. No significant changes were observed in the remaining secondary outcomes. CONCLUSIONS This study suggests that an HF TM program, which provides patients with self-care support and active monitoring by their existing care team, can reduce health service utilization and improve clinical, QoL, and patient self-care outcomes.

scholarly journals Does an empowerment-based self-care supportive intervention save cost for improving self-care and health service utilization among heart failure patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D.S.F Yu ◽  
P.W.C Li ◽  
S Yu ◽  
B Yan ◽  
J Wong
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Health Service ◽  
Cost Saving ◽  
Hospital Admission ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Self Care ◽  
Care Program ◽  
Hospital Service

Abstract Background Heart failure (HF) evolves as a global pandemic and strains the over-stretched hospital service. Ineffective self-care remains the key factor to explain the avoidable hospital admission. Patient empowerment is as a theory-based strategy to optimize the patients' self-care changes for disease management [1]. Its cost-effectiveness to enhance self-care and health service utilization has yet to be determined. Purpose This was a double-blind randomized controlled trial to compare the effects and cost-effectiveness of a 12-week empowerment self-care program with a didactic education program on self-care maintenance and management as well as health service utilization among the community-dwelling HF patients. Methods A total of 236 HF patients were recruited from the specialist clinics of the Department of Cardiology in two regional hospitals. They were randomized to receive either the 12-week empowerment self-care program (Figure 1) or the 12-week didactic education. Outcome evaluation using the Self-care Heart Failure Index (SCHFI) at baseline, post-intervention (T1) and three months thereafter (T2), with record on the number of emergency room (ER) attendance and hospital admission. Cost effectiveness analyses were performed on total cost (medical, intervention and societal costs) incurred in both interventions as well as incremental cost-effectiveness ratios (ICER) expressed as incremental cost per 1) a reflected clinically meaningful improvement in self-care (i.e. a half standard deviation increase in SCHFI), 2) an ER attendance reduced, 3) a day of hospital stay reduced. Results As compared with the education group, the empowerment group reported significantly greater improvement in self-care management at T1 [B=13.77 (95% CI=6.07, 21.46), p&lt;0.001] and T2 [B=10.98 (95% CI=3.21, 18.75), p=0.006]. For cost-effective analysis, The ICER (empowerment-education) was −USD220/0.5 SD increase in SCHFI, indicating the mean cost saved per patient for making a clinically significant improvement in self-care was USD 220. The cost-effectiveness acceptability curve showed patients were willing to pay at USD 207- 441 for a 80–90% chance of improved self-care, indicating that the empowerment approach was a cost saving strategy. Although the empowerment approach was associated with a lower risk of ER attendance [IRR=0.55, 95% CI=0.31–0.95)] and hospital admission [IRR=0.38 (95% CI=0.31–0.95)], it is not cost saving for reducing hospital service utilization. Conclusions The empowerment-based self-care program is a cost-saving strategy to produce a clinical significant change in HF-related self-care. Although it is associated with lower risk for hospital service utilization, its effect is not significant enough to be cost-saving. Future care model may explore the need to integrate dyadic science [2] and e-health [3] to strengthen the care continuity and effects of self-care intervention. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health and Medical Research Fund, Food and Health Bureau, Hong Kong Special Administrative Region Figure 1

scholarly journals IMPACT OF HEALTH LITERACY ON KNOWLEDGE, SELF-CARE AND CLINICAL OUTCOMES IN HEART FAILURE PATIENTS

2018 ◽  
Vol 34 (10) ◽  
pp. S93
Author(s):  
J. McConnery ◽  
F. Foroutan ◽  
A. Alba ◽  
H. Ross ◽  
J. MacIver
Keyword(s):  
Heart Failure ◽  
Health Literacy ◽  
Clinical Outcomes ◽  
Self Care ◽  
Heart Failure Patients
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