Effect of Nurse-Implemented Transitional Care for Chinese Individuals with Chronic Heart Failure in Hong Kong: A Randomized Controlled Trial.
OBJECTIVE
To determine the effect of nurse-implemented transitional care (TC) on readmission and mortality rates in Chinese individuals with chronic heart failure (CHF) in Hong Kong.


METHODS
Single-center randomized controlled trial of TC versus usual care (UC).


METHODS
University-affiliated hospital in Hong Kong.


METHODS
Hospitalized Chinese individuals with CHF (N = 178; aged 78.6 ± 6.9, 45% male).


METHODS
The TC group received a predischarge visit, two home visits, and then regular telephone calls over 9 months to provide self-care education and support, optimized health surveillance, and facilitation in use of community services. Primary endpoints were event-free survival, all-cause hospital readmission, and mortality during the 9-month follow-up. Secondary endpoints were length of hospital stay, self-care, and health-related quality of life (HRQL). Data were analyzed using survival analysis and generalized estimating equations, following an intention-to-treat principle.


RESULTS
Survival analysis indicated no significant differences in event-free survival, hospital readmission, or mortality between the TC and UC groups, although the TC group had a lower hospital readmission rate at 6 weeks (8.1% vs 16.3%, P = .048) and lower mortality at 9 months (4.1% vs 13.8%, P = .03). The TC group also had a shorter hospital stay (P = .006) and significantly better self-care and HRQL. Because of attrition, sensitivity analyses were conducted to examine whether the intention-to-treat assumption affected the results. Per-protocol population analyses (hazard ratio (HR) = 0.40, 95% confidence interval (CI) = 0.17-0.93) and worst-case-scenario analysis (HR = 0.44, 95% CI = 0.25-0.77) suggested a lower mortality risk in the TC group.


CONCLUSIONS
The translation of individual-centered nurse-implemented TC to the Chinese culture and healthcare context of Hong Kong appears beneficial.
Nethersole School of Nursing, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Doris S F
DS
Yu
Nethersole School of Nursing, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Diana T F
DT
Lee
Mary MacKillop Institute of Health Research, Melbourne, Victoria, Australia.|Australian Catholic University, Melbourne, Victoria, Australia.
Simon
S
Stewart
Centre for the Heart and Mind, Melbourne, Victoria, Australia.
David R
DR
Thompson
Nethersole School of Nursing, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Kai-Chow
KC
Choi
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Cheuk-Man
CM
Yu
D000368:Aged; D003266:Continuity of Patient Care; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000451:nursing*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chronic heart failure; hospital readmission; mortality; older adult; self-care; transitional care