A home health intervention for CHF patients reduced the variation in nursing visits provided (p<0.05) and marginally reduced visit volume (p=0.074), without improving other clinical outcomes.
RCT (n=371)
Randomized
No
Does a home health intervention improve outcomes and reduce healthcare utilization in Medicare CHF patients?
A home health intervention for CHF patients reduced the variation and volume of skilled nursing visits but did not significantly improve hospital admissions, QoL, or survival at 90 days.
This study examines the effects of a home health intervention designed to standardize nursing care, strengthen nurses' support for patient self-management and yield better CHF patient outcomes. Participants were 371 Medicare CHF patients served by 205 nurses randomized to intervention and control groups in a large urban home healthcare agency (HHA). The intervention consisted of an evidence-based nursing protocol, patient self-care guide, and training to improve nurses'teaching and support skills. Outcome measures included home care,physician and emergency department (ED) use, hospital admission, condition-specific quality of life (QoL), satisfaction with home care services and survival at 90 days. The intervention was associated with a marginally significant reduction in the volume of skilled nursing visits (p = .074), and a reduction variation in the typical number of visits provided (p < .05), without a significant increase in physician or ED use or patient mortality. Hypothesized improvement in other outcomes did not occur.
Feldman et al. (Mon,) conducted a rct in Congestive Heart Failure (n=371). Home health intervention (evidence-based nursing protocol, patient self-care guide, and training) vs. Control was evaluated on Home care, physician and emergency department use, hospital admission, condition-specific quality of life, satisfaction with home care services and survival at 90 days. A home health intervention for CHF patients reduced the variation in nursing visits provided (p<0.05) and marginally reduced visit volume (p=0.074), without improving other clinical outcomes.