Home Care NetWork
Home Care Literature Review: January– June 2006
Cardiovascular Disease:
Inglis SC, Pearson S, Treen S, Gallasch T, Horowitz JD, Stewart S. Extending the horizon in chronic heart failure: effects of multidisciplinary, home-based intervention relative to usual care. Circulation 2006; 114:2466-2473. Epub 2006 Nov 20
This Australian randomized clinical trial evaluated the long-term (up to 10 years of
follow-up, with a minimum 7.5 years of follow-up) impact of home-based chronic heart failure management programs in an elderly cohort of patients with chronic heart failure initially randomized to either the program (n=149) or usual postdischarge care (n=148) following short-term hospitalization. Median survival in the program cohort was almost twice that of usual care (40 vs 22 months; p<0.001), with fewer deaths overall (77% vs 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; p<0.001). The program cohort had prolonged event-free survival (median, 7 vs 4 months; p<0.01). While program patients had more unplanned readmissions (560 vs 550), it took 7 years for these admissions to overtake the usual care rate. Readmissions (2.04+/-3.23 vs 3.66+/-7.62 admissions; p<0.05) and related hospital stay (14.8+/-23.0 vs 28.4+/-53.4 days per patient per year; p<0.05) were significantly lower in the program group. The program demonstrated 120 more life-years per 100 patients treated compared with usual care (405 vs 285 years) at a cost of $1,729 (Australian dollars) per additional life-year gained based on all health-care costs associated with the program. This is a remarkably successful program based on this report. These findings are consistent with the literature from this country.
Sisk JE, Hebert PL, Horowitz CR, McLaughlin MA, Wang JJ, Chassin MR. Effects of nurse management on the quality of heart failure care in minority communities: a randomized trial. Ann Intern Med 2006; 145:273-283
This randomized clinical trial evaluated a disease management program led by bilingual nurses who counseled patients on diet, medication adherence, and self-management of symptoms by way of an initial visit and regularly scheduled follow-up telephone calls and facilitated evidence-based changes to medications in discussions with patients' clinicians. Patients were recruited from four hospitals in Harlem, New York, and included 406 adults (45.8% non-Hispanic black adults, 32.5% were Hispanic adults, 46.3% were women, and 36.7% were > or =65 years of age). After 1 year, the program's patients had had fewer hospitalizations (143 hospitalizations vs 180 hospitalizations; adjusted difference, -0.13 hospitalization/person-year [95% CI, -0.25 to -0.001 hospitalization/person-year]) and were functioning a higher level than usual care patients. Deaths (22 deaths in each group) and percentages of patients hospitalized at least once (30.5% program patients vs 36.5% usual care patients; adjusted difference, -7.1% [CI, -16.9 to 2.6 percentage points]) were similar in each group. Another successful disease management program for heart failure. This one is particularly interesting because of a diverse, minority, patient population.
Gregory D, Kimmelstiel C, Perry K, Parikh A, Konstam V, Konstam MA.
Hospital cost effect of a heart failure disease management program: the Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) trial. Am Heart J 2006; 151:1013-1018
This large database analysis generated cost estimates from a subsample of patients enrolled in a heart failure disease management (HFDM) program and found that, while the HFDM trended toward reduced heart failure hospitalizations (relative odds of at least one all-cause hospitalization during the HFDM compared with the control group = 0.76 (95% CI 0.38-1.51), the HFDM cost more. The point estimate of the differential hospitalization cost between HFDM and control groups was a reduction in cost of $375 per patient, but the net effect, including the costs of the program, was an increase of $488 per patient for the HFDM group. As is the case with many home care, this program had improved quality and reduced hospitalizations but incurred extra costs.
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