Monday, November 5, 2007

This presentation is part of : Outcomes of Care Strategies
A Comparison of Home Management Methods to Improve Outcomes for African-American Patients with Chronic Heart Failure
Mary D. Bondmass, RN, PhD, Department of Physiologic Nursing, University of Nevada Las Vegas, Las Vegas, NV, USA
Learning Objective #1: identify two possible methods of home management for African American patients with chronic heart failure.
Learning Objective #2: discuss the efficacy of home management methods relative to biopsychosocial outcomes for African American Patients with chronic heart failure.

BACKGROUND: Home management of chronic heart failure (CHF) continues to challenge health care providers. This is of particular concern for African American (AA) patients, who have higher incidence rates of CHF compared to Caucasians.

PURPOSE: The purpose of this study was to compare two home management methods to determine which was more efficacious at improving selected biopsychosocial outcomes for AA patients with CHF.    

METHODS: A prospective randomized design was used for this study. Prior to discharge from a HF hospitalization, 186 AA patients, New York Heart Association (NYHA) functional class III-IV, were randomized to receive one of two home interventions for management of their CHF. Subjects received either home monitoring with telemanagement (HMT) (n = 90, mean 62.1 ± 13.6 yrs, 63.3 % female) or home nurse visits (HNV) (n = 96, mean 62.8 ± 12.4 yrs, 60.4% female). Outcomes, measured at three months post intervention, included HF self-efficacy, quality of life, psychological and symptom distress. Wilcoxon-Mann-Whitney U, Chi-square, and ANOVA tests was used for between-group analyses relative to the level and distribution of the data.

RESULTS: No significant baseline differences were found between the groups for age, gender, NYHA functional class, left ventricular ejection fraction, or insurance provider.  Following the intervention period, patients who were in the HMT group had significantly higher overall scores for self-efficacy (p = ≤ 0.000) and quality of life (p = ≤ 0.000), and lower scores for psychological and symptom distress (p = ≤ 0.000) compared to patients in the HNV group. Additionally, intervention costs were significantly lower (p = ≤ 0.000)   for the HMT group.  

CONCLUSION: These data suggest that home monitoring with telemanagement may be more efficacious when compared to home nurse visits at improving certain biopsychosocial outcomes, at lower intervention costs, for the home management of CHF for African American patients.