Teach-Back Is an Effective Strategy for Educating Older Heart Failure Patients

Abstract

Teach-back is endorsed by organizations such as the Institute for Healthcare Improvement as an effective method for confirming understanding of health care information in heart failure (HF) patients. Despite this endorsement, no study has demonstrated the effectiveness of teach-back for learning in HF patients. Aim: To determine whether older hospitalized HF patients educated with the teach-back method can learn and retain self-care information following hospital discharge. Methods: Self-care was taught to patients $65 years who were hospitalized for HF using the teach-back method. Self-care topics included: high salt foods, when to call the MD, when to report weight gain, and diuretics. One teach-back question for each topic was developed. Successful learning was assessed in patients while hospitalized and 6-8 days after hospital discharge. Results: Subjects’ (N5276) mean age was 80+8.9 and 55% (n5153) were female. Within 30 days of hospital discharge 41 (14.9%) patients were readmitted and 52 (19%) died within 12 months. Prior to hospitalization, 86 (31%) were independent with their activities of daily living. Following education using teach-back principles, 233 (84%) patients correctly answered three out of four (75%) of the teach-back questions. Upon follow-up at 6-8 days, 145 (77%) patients correctly answered 75% of the teach-back questions. Correctly versus incorrectly answered questions were associated with longer teaching times (36 minutes vs 27 minutes, p.!001). Patients who were discharged to a skilled nursing facility answered fewer questions correctly (p5.005). The most often correctly answered question while hospitalized and after discharge, was on the topic of high salt foods (98%). The most often incorrectly answered question was when to report weight gain (75%). When to report weight gain was also associated with significant loss of retention (p5.001) from time of hospitalization to follow-up. Conclusions: Teach-back was a remarkably effective method to assess and teach self-care learning in hospitalized HF patients and after discharge, despite patients’ older age and lack of independent function. However, effective teaching requires adequate and dedicated time for nurses to teach. Teaching focused on when to report weight gain was more often needed than teaching focused on high salt foods. Future research linking teachback, self-care and readmissions is needed.