Effects of a home-based activation intervention on self-management adherence and readmission in rural heart failure patients: the PATCH randomized controlled trial.

Lufei Young,Melody Hertzog,Susan Barnason

doi:10.1186/s12872-016-0339-7

Lufei Young, Melody Hertzog + Show 1 more

Open Access

https://doi.org/10.1186/s12872-016-0339-7

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Abstract

BackgroundHeart failure (HF) patients discharged from rural hospitals have higher 30-day readmission rates. Self-management (SM) reduces readmissions, but adherence to SM guidelines is low in the rural HF population. We tested a home-based intervention to enhance patient activation and lead to improved SM adherence.MethodsIn this two-group, repeated measures randomized control trial, the main outcomes were patient reported and clinical outcomes associated with SM adherence, and all-cause readmission at 30, 90 and 180 days.ResultsThe study included 100 HF patients discharged from a rural critical access hospital. The intervention group received a 12-week SM training and coaching program delivered by telephone and tailored on subjects’ activation levels. At α = .10, the PATCH intervention showed significantly greater improvement compared to usual care in patient-reported SM adherence: weighing themselves, following a low-sodium diet, taking prescribed medication, and exercising daily (all p < .0005) at 3 and 6 months after discharge. In contrast, groups did not differ in physical activity assessed by actigraphy or in clinical biomarkers. Contrary to expectation, the 30-day readmission rate was significantly higher (p = .088) in the intervention group (19.6 %) than in the control group (6.1 %), with no differences at 90 or 180 days.ConclusionIt is feasible to conduct a randomized controlled trial in HF patients discharged from rural critical access hospitals. Significantly higher patient-reported SM adherence was not accompanied by lower clinical biomarkers or readmission rates. Further research is needed to understand mechanisms that influence outcomes and healthcare utilization in this population.Trial registrationClinical Trial Registration Information: ClinicalTrials.gov; NCT01964053.

Highlights

Heart failure (HF) patients discharged from rural hospitals have higher 30-day readmission rates
The purpose of this study is to examine the effects of a 12-week patient activation intervention (Patient AcTivated Care at Home [PATCH]) on the improvement of SM adherence and its health outcome in HF patients following discharge from critical access hospital (CAH)
Three subjects were excluded from the PATCH intervention group and two from the control group as described in the CONSORT study flow diagram (Fig. 1)

Summary

Introduction

Heart failure (HF) patients discharged from rural hospitals have higher 30-day readmission rates. Self-management (SM) reduces readmissions, but adherence to SM guidelines is low in the rural HF population. We tested a home-based intervention to enhance patient activation and lead to improved SM adherence. Compared to their urban counterparts, HF patients discharged from rural hospitals, primarily critical access hospitals (CAHs), have higher 30-day readmission [1]. Failing to adhere to self-management (SM) guidelines accounted for 50 % of hospital readmissions in HF patients [2]. Rural patients may have lower self-management knowledge and health literacy [5], lack of HF-specific SM education and counselling from providers [6], and lack of SM support [7]. Past research has been limited by lack of a theoretical framework [8], unclear mechanism of the intervention [9], and lack of objective measures of SM adherence [10]

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