Pilot Implementation of a Low-Literacy Zone Tool for Heart Failure Self-Management (QI808)

Abstract

•Name and define the 3 components of HF self-care, according to Riegel et al's revised theory.•Describe the meaning and practical significance of the 3 different colored zones in the Zone Tool for Heart Failure Self-Management used in this QI project.•Identify methods by which this QI project's lead evaluated feasibility of the HF zone tool. Heart failure (HF) affects 6.5 million Americans, with 1 million hospitalizations annually, a 21.9% readmission rate, and $31 billion in healthcare costs. Palliative care (PC) decreases HF patients' symptom burden, readmissions, and costs. Many elderly patients have difficulty recognizing and reporting HF symptoms to their providers in a timely manner. Self-care tools with color-coded zones (green = all clear; yellow = caution; red = take action) help patients recognize and respond to HF symptoms and reduce readmissions and costs. The purposes of this quality improvement (QI) pilot project were to evaluate the feasibility of implementing a low-literacy zone tool for HF self-management with home-based PC patients and to test the zone tool's effect on self-care and quality of life. An interdisciplinary PC team developed a zone tool for HF self-management. Fifteen patients with advanced HF in a home-based PC program were recruited for this QI project. Health literacy was prescreened with the Newest Vital Sign instrument. HF self-care and quality of life were measured respectively with the Self-Care of Heart Failure Index and the Kansas City Cardiomyopathy Questionnaire at baseline, 30 days, and 60 days. In post-implementation surveys, participants and nurses rated the zone tool's readability and helpfulness (feasibility). Analyses of variance (ANOVA's) evaluated the zone tool's effect on self-care and quality of life. Participants evaluated the zone tool as easy to understand and helpful in recognizing and reporting HF symptoms. Due to the small sample size, ANOVA's were inconclusive regarding the effect of the HF zone tool on the two primary outcomes of interest. This QI project demonstrated the feasibility of implementing a zone tool for HF self-management for patients in a home-based PC program. Further research with larger samples is needed to assess HF zone tools' effect on self-care and quality of life.