Comparing Perspectives of Patients, Caregivers, and Clinicians on Heart Failure Management.
BACKGROUND
Although substantial effort has been devoted to reducing readmissions among heart failure (HF) patients, little is known about factors identified by patients and caregivers that may contribute to readmissions. The goal of this study was to compare the perspectives of HF patients, their caregivers, and their care team on HF management and hospital admissions. Understanding these perspectives may lead to better strategies for improving care during the post-hospital transition and for reducing preventable readmissions.


RESULTS
We performed freelisting, an anthropologic technique in which participants list items in response to a question, with hospitalized HF patients (n = 58), their caregivers (n = 32), and clinicians (n = 67). We asked about home HF management tasks, difficulties in managing HF, and perceived reasons for hospital admission. Results were analyzed with the use of Anthropac. Salience indices (measures of the most important words for defining the domain of interest) were calculated. Patients and clinicians described similar home HF management tasks, whereas caregivers described tasks related to activities of daily living. Clinicians cited socioeconomic factors as challenges to HF management, whereas patients and caregivers cited limited functional status and daily activities. When asked about reasons for hospitalization, patients and caregivers listed distressing symptoms and illness, whereas clinicians viewed patient behaviors to be primarily responsible for admission.


CONCLUSIONS
These findings highlight that although some similarities exist, there are important differences among patients, caregivers, and clinicians in how they perceive the challenges of HF management and reasons for readmission. Understanding these differences may be critical to developing strategies to reduce readmissions.
Northwestern University, Chicago, Illinois. Electronic address: faraz.ahmad@northwestern.edu.
Faraz S
FS
Ahmad
University of Pennsylvania, Philadelphia, Pennsylvania.
Frances K
FK
Barg
University of Pennsylvania, Philadelphia, Pennsylvania.
Kathryn H
KH
Bowles
University of Pennsylvania, Philadelphia, Pennsylvania.
Madeline
M
Alexander
University of Pennsylvania, Philadelphia, Pennsylvania.
Lee R
LR
Goldberg
University of Pennsylvania, Philadelphia, Pennsylvania.
Benjamin
B
French
University of Pennsylvania, Philadelphia, Pennsylvania.
Shreya
S
Kangovi
University of Pennsylvania, Philadelphia, Pennsylvania.
Thomas R
TR
Gallagher
University of Pennsylvania, Philadelphia, Pennsylvania.
Breah
B
Paciotti
University of Pennsylvania, Philadelphia, Pennsylvania.
Stephen E
SE
Kimmel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010819:Physician's Role / Q000523:psychology*; D011795:Surveys and Questionnaires
Heart failure; patient-centered care; qualitative research; readmissions; transitional care