title: Patient, Caregiver, and Physician Work in Heart Failure Disease Management: A Qualitative Study of Issues That Undermine Wellness.
abstract: To identify factors underlying heart failure hospitalization.
  
  
  
  Between January 1, 2012, and May 31, 2012, we combined medical record reviews and cross-sectional qualitative interviews of multiple patients with heart failure, their clinicians, and their caregivers from a large academic medical center in the Midwestern United States. The interview data were analyzed using a 3-step grounded theory-informed process and constant comparative methods. Qualitative data were compared and contrasted with results from the medical record review.
  
  
  
  Patient nonadherence to the care plan was the most important contributor to hospital admission; however, reasons for nonadherence were complex and multifactorial. The data highlight the importance of patient education for the purposes of condition management, timeliness of care, and effective communication between providers and patients.
  
  
  
  To improve the consistency and quality of care for patients with heart failure, more effective relationships among patients, providers, and caregivers are needed. Providers must be pragmatic when educating patients and their caregivers about heart failure, its treatment, and its prognosis.
authors: Office of Clinical Practice Innovation, George Washington University School of Medicine and Health Sciences, Washington, DC; Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: safarmer@gwu.edu.
authors: Steven A
authors: SA
authors: Farmer
authors: Department of Occupational Therapy, University of Illinois at Chicago.
authors: Susan
authors: S
authors: Magasi
authors: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Phoebe
authors: P
authors: Block
authors: Wake Forest School of Medicine, Winston-Salem, NC.
authors: Megan J
authors: MJ
authors: Whelen
authors: Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Luke O
authors: LO
authors: Hansen
authors: Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Robert O
authors: RO
authors: Bonow
authors: Northwestern Memorial Hospital, Chicago, IL.
authors: Philip
authors: P
authors: Schmidt
authors: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Ami
authors: A
authors: Shah
authors: Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Surgery, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Kathleen L
authors: KL
authors: Grady
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy; D006801:Humans; D007297:Inpatients / Q000193:education / Q000523:psychology*; D007348:Insurance, Health / Q000191:economics / Q000592:standards*; D007407:Interviews as Topic; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015146:Midwestern United States; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards; D010359:Patient Readmission / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D012307:Risk Factors; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data