Foreground of the problem: The estimated cost of heart failure readmissions is soaring. Improper and poor management of chronic heart failure is burdening healthcare systems around the world.
Purpose: The purpose of this project was to explore if a nurse practitioner-led heart failure treatment team reduced the percentage of thirty-day hospital readmissions and in turn decreased healthcare costs and improved patients’ quality of life.
Theoretical framework: The Expanded Chronic Care Model (ECCM) is the theoretical framework for the project. The ECCM recommends the use of promotion of self-management, use of community health resources, promotion of support systems at home or within the community, and overall promotion of healthy living. These same approaches serve as the basis for this project design and intervention.
Review of evidence: The evidence suggests that a nurse practitioner-led intervention will decrease thirty-day hospital readmissions of heart failure patients. Incorporation of home health services is an essential component of the proposed plan. The patients’ socioeconomic factors and educational needs will be evaluated to optimize the project’s success.
Project design: This pilot project used a convenience sample with a randomized intervention group and a randomized non-intervention group. The design for the project’s intervention group incorporated nurse practitioner-led coordination of care, which included the management, evaluation, treatment, and education of the patient with heart failure. The project design also included the use of home health services and ancillary staff (e.g. dietary, pharmacy, care coordination, and home health). The initial intervention began in the hospital setting where management of the heart failure patient’s symptoms and status was be optimized. Education by the NP, the pharmacy staff, the nursing staff, and dietary specialists was provided to the patient during hospitalization. Upon discharge, the patients’ care was managed by the nurse practitioner in collaboration with home health services. The intervention took place in a 177-bed community hospital as well as in a clinic setting. The population included patients who have heart failure NYHA class I-III, ages fifty-five and older. Each patient in the intervention group was followed for thirty days. The project continued for three months. The data for the non-intervention group was obtained through retrospective chart review retrieved from hospital data bases.
Significance: Using a nurse practitioner-led intervention has the potential to reduce thirty-day hospital readmissions of heart failure patients, thereby decreasing health care costs and financial burden on the patient, as well as improving the patient’s self-care and quality of life.
|Advisor:||Perry, Anne G.|
|School:||Southern Illinois University at Edwardsville|
|School Location:||United States -- Illinois|
|Source:||DAI-B 76/10(E), Dissertation Abstracts International|
|Subjects:||Nursing, Health care management|
|Keywords:||Heart failure, Nurse practioner, Readmission prevention, Readmission reduction|
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