title: Advanced practice nurse strategies to improve outcomes and reduce cost in elders with heart failure.
abstract: The aim of this study was to investigate whether, in a randomized controlled trial (RCT) of vulnerable elders with heart failure (HF), advanced practice nurses (APNs) who were coordinating care in the transition from hospital to home could improve outcomes, prevent rehospitalizations, and reduce costs when compared with usual care. The APN strategies focused on improving patient and family or caregiver effectiveness in managing their illnesses, strengthening the patient-provider relationship, and managing comorbid conditions while improving overall health. The results were positive. By capitalizing on the patient's desire to achieve their identified goals, APNs successfully educated patients about the meaning of their symptoms and appropriate self-management strategies; improved patient-provider communication patterns; and marshaled caregiver and community resources to maximize patient adherence to the treatment plan and overall quality of life. While HF was the primary reason for enrollment in the study, optimal health outcomes demanded a strong focus on integrating management of comorbid conditions and other long-standing health problems. Specific strategies used by the APN to achieve these positive outcomes are addressed in this report. These strategies are compared with nursing interventions used in other RCTs of HF home management. Directions for future research are explored.
authors.affiliation: Department of Cardiovascular Nursing, University of Pennsylvania School of Nursing, Philadelphia, 19104-6096, USA. kmccaule@nursing.upenn.edu
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: McCauley
authors.forename: M Brian
authors.initials: MB
authors.lastname: Bixby
authors.forename: Mary D
authors.initials: MD
authors.lastname: Naylor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003266:Continuity of Patient Care; D003365:Costs and Cost Analysis; D006331:Heart Diseases / Q000191:economics* / Q000451:nursing*; D006801:Humans; D009729:Nursing / Q000379:methods*; D015403:Nursing Evaluation Research; D016896:Treatment Outcome