Effect of Post Discharge Follow-up on Readmission Rates for Congestive Heart Failure Patients
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 21
- 试验地点
- 1
- 主要终点
- The time from hospital discharge to first hospital readmission or death.
研究概览
简要总结
The purpose of this study is to test the hypothesis that a comprehensive post-discharge disease management system is more effective in reducing the readmission rate for heart failure patients compared to standard care.
详细描述
Heart failure, a disease that affects a large proportion of the aging population, continues to be associated with poor outcomes especially in patients who require hospitalization. Each year, nearly 1 million Americans are newly diagnosed with congestive heart failure and currently, there are at least 5 million Americans living with this chronic disease. The number of patients with heart failure is expected to reach 10 million by the year 2037.This population consumes a large proportion of health care resources with the main cost being hospitalization. The heart failure 30-day readmission rates hover around 25% nationally, with an approximate cost of $7,000 per hospitalization.
In an effort to improve care and reduce costs, heart failure disease management programs are becoming more prevalent. Recent data suggests that multi-disciplinary disease management programs may reduce mortality and hospitalizations as well as improve costs, patients' ability to self-care, and quality of life. It provides a means to increase the use of evidence-based therapies, improve patient education, and decrease resource usage. Heart failure management programs involve early assessment, optimized treatment, easy access to care, and education and psychosocial support.
Patients hospitalized for decompensated congestive heart failure are among the highest risk group for morbidity and mortality among people with chronic heart failure and a large proportion of this risk occurs early after discharge. Thus, the goals of these programs should include managing the gap between the inpatient and outpatient settings and should ideally involve a multidisciplinary team in order to serve these patients in a comprehensive manner. We propose to determine the relative efficacy of a post-discharge disease management system.
PRIMARY OBJECTIVE:
The primary objective of this study is to determine if the time to first hospital readmission can be lengthened using a disease management model.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age =/or >18
- •Admitted to the Heart Failure Unit with acute decompensated heart failure
- •Referred to the Congestive Heart Failure Disease Management Program
排除标准
- •Mentally incapacitated
- •Discharge to a skilled nursing facility
结局指标
主要结局
The time from hospital discharge to first hospital readmission or death.
时间窗: basline and 1 month
The primary endpoint will be assessed as a continuous variable. Survival curves will be produced using Kaplan-Meier analysis for both the CHF Disease Management Group and the case control group. A Cox regression-based test will be used to test differences in survival between the CHF Disease Management Group and the case control group. If case control subjects cannot be exactly matched on covariates to CHF Disease Management subjects, inverse probability of treatment weights (obtained via logistic regression) will be applied to correct for covariate imbalances between the two groups.
次要结局
- The time from hospital discharge to unplanned hospital admission for acute decompensated heart failure.(baseline and 3 months)
- Change in quality of life.(baseline and 2 months)
- Mean readmission cost for each patient for total cost for each readmission.(baseline and 3 months)
- Improvement in knowledge of Heart Failure(baseline and 2 months)