title: Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol.
abstract: Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients' health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH]) to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only) to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden.
  
  
  BACKGROUND
  ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053.
authors.affiliation: College of Nursing-Lincoln Division, University of Nebraska Medical Center, Lincoln, NE 68588-0220, USA.
authors.forename: Lufei
authors.initials: L
authors.lastname: Young
authors.affiliation: College of Nursing-Lincoln Division, University of Nebraska Medical Center, Lincoln, NE 68588-0220, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Barnason
authors.affiliation: Department of Health Services Research & Administration College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4350, USA.
authors.forename: Van
authors.initials: V
authors.lastname: Do
keywords: adherence; heart failure; patient activation; self-management