Just-in-time evidence-based e-mail "reminders" in home health care: impact on patient outcomes.
OBJECTIVE
To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients.


METHODS
Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF.


METHODS
Patients were treated by nurses randomly assigned to usual care or one of two intervention groups. The basic intervention was an e-mail to the patient's nurse highlighting six HF-specific clinical recommendations. The augmented intervention supplemented the initial nurse reminder with additional clinician and patient resources.


METHODS
Patient interviews were conducted 45 days post admission to measure self-management behaviors, HF-specific outcomes (Kansas City Cardiomyopathy Questionnaire-KCCQ), health-related quality of life (EuroQoL), and service use.


RESULTS
Both interventions improved the mean KCCQ summary score (15.3 and 12.9 percent, respectively) relative to usual care (p< or =.05). The basic intervention also yielded a higher EuroQoL score relative to usual care (p< or =.05). In addition, the interventions had a positive impact on medication knowledge, diet, and weight monitoring. The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes.


CONCLUSIONS
This study demonstrates the positive impact of targeting evidence-based computer reminders to home health nurses to improve patient self-care behaviors, knowledge, and clinical outcomes. It also advances the field's limited understanding of the cost-effectiveness of selected strategies for translating research into practice.
Feldman
Penny H
PH
Center for Home Care Policy & Research, Visiting Nurse Service of New York, 107 East 70th Street, New York, NY 10021, USA.
Murtaugh
Christopher M
CM
Pezzin
Liliana E
LE
McDonald
Margaret V
MV
Peng
Timothy R
TR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003152:Community Health Nursing / Q000592:standards*; D004059:Diffusion of Innovation; D019468:Disease Management; D034742:Electronic Mail; D019317:Evidence-Based Medicine; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000451:nursing / Q000517:prevention & control* / Q000523:psychology; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D012648:Self Care; D014481:United States