title: Quality of life of individuals with heart failure: a randomized trial of the effectiveness of two models of hospital-to-home transition.
abstract: BACKGROUND
  The growing number of patients with congestive heart failure has increased both the pressure on hospital resources and the need for community management of the condition. Improving hospital-to-home transition for this population is a logical step in responding to current practice guidelines' recommendations for coordination and education. Positive outcomes have been reported from trials evaluating multiple interventions, enhanced hospital discharge, and follow-up through the addition of a case management role. The question remains if similar gains could be achieved working with usual hospital and community nurses.
  
  
  METHODS
  A 12-week, prospective, randomized controlled trial was conducted of the effect of transitional care on health-related quality of life (disease-specific and generic measures), rates of readmission, and emergency room use. The nurse-led intervention focused on the transition from hospital-to-home and supportive care for self-management 2 weeks after hospital discharge.
  
  
  RESULTS
  At 6 weeks after hospital discharge, the overall Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was better among the Transitional Care patients (27.2 +/- 19.1 SD) than among the Usual Care patients (37.5 +/- 20.3 SD; P = 0.002). Similar results were found at 12 weeks postdischarge for the overall MLHFQ and at 6- and 12-weeks postdischarge for the MLHFQ's Physical Dimension and Emotional Dimension subscales. Differences in generic quality life, as assessed by the SF-36 Physical component, Mental Component, and General Health subscales, were not significantly different between the Transition and Usual Care groups. At 12 weeks postdischarge, 31% of the Usual Care patients had been readmitted compared with 23% of the Transitional Care patients (P = 0.26), and 46% of the Usual Care group visited the emergency department compared with 29% in the Transitional Care group (chi2 = 4.86, df 1, P = 0.03).
  
  
  CONCLUSIONS
  There were significant improvements in health-related quality of life (HRQL) associated with Transitional Care and less use of emergency rooms.
authors.affiliation: School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada. harrisnm@post.queensu.ca
authors.forename: Margaret B
authors.initials: MB
authors.lastname: Harrison
authors.forename: Gina B
authors.initials: GB
authors.lastname: Browne
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Roberts
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
mesh_terms: D000328:Adult; D000359:Aftercare / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care / Q000592:standards*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000451:nursing*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000592:standards*; D010353:Patient Education as Topic; D010359:Patient Readmission; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires