title: A randomized intervention to improve heart failure outcomes in community-based home health care.
abstract: This study examines the effects of a home health intervention designed to standardize nursing care, strengthen nurses' support for patient self-management and yield better CHF patient outcomes. Participants were 371 Medicare CHF patients served by 205 nurses randomized to intervention and control groups in a large urban home healthcare agency (HHA). The intervention consisted of an evidence-based nursing protocol, patient self-care guide, and training to improve nurses'teaching and support skills. Outcome measures included home care,physician and emergency department (ED) use, hospital admission, condition-specific quality of life (QoL), satisfaction with home care services and survival at 90 days. The intervention was associated with a marginally significant reduction in the volume of skilled nursing visits (p = .074), and a reduction variation in the typical number of visits provided (p < .05), without a significant increase in physician or ED use or patient mortality. Hypothesized improvement in other outcomes did not occur.
authors.affiliation: Center for Home Care Policy and Research, Visiting Nurse Service of New York, NY 10021, USA. pfeldman@vnsny.org
authors.forename: Penny H
authors.initials: PH
authors.lastname: Feldman
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Peng
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Murtaugh
authors.forename: Catherine
authors.initials: C
authors.lastname: Kelleher
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Donelson
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: McCann
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Putnam
mesh_terms: D000368:Aged; D019058:Community Networks; D005260:Female; D006302:Health Services Research; D006333:Heart Failure / Q000628:therapy*; D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011788:Quality of Life