Self-management Adherence in Heart Failure Patients (PATCH)
Heart Failure
About this trial
This is an interventional treatment trial for Heart Failure focused on measuring Self-management adherence, post acute care, critical access hospitals, patient activation, hospital readmission
Eligibility Criteria
Inclusion Criteria:
- have HF as one of their discharge diagnoses;
- have New York Heart Association (NYHA) class II to IV symptoms or have NYHA class I symptoms
- have had at least one other HF-related hospitalization or emergency department visit in the previous year;
- are discharged to home;
- pass a mini-cog screen
- understand English;
- have access to a phone.
Exclusion Criteria:
- Have scheduled procedures and/or surgeries during hospitalization;
- Have depressive symptoms (receive a score of 3 or above on the Patient Health Questionnaire-2 (PHQ-2) have documented medical diagnosis or diagnostic evidence of liver cirrhosis;
- Have renal failure (serum creatinine greater than 2.0mg/dl)
Sites / Locations
- Beatrice Community Hospital & Health Center
- Jefferson Community Health Center
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
PATCH Intervention
Usual Care
The intervention group will receive usual care and the PATCH intervention. The intervention is comprised of two phases in which the in-hospital discharge education session is followed by 12 weeks of post-discharge education sessions delivered by telephone. The focus of this study is to test the mechanism of the proposed patient activation intervention on HF self-management adherence and associated health outcomes.
The usual care group will receive standardized discharge written information and scheduled doctor appointments. Standardized discharge instruction, as recommended by CMS and the Joint Commission, includes: activity level, diet, discharge medications, follow-up doctor appointment, weight monitoring, and what to do if symptoms worsen. No further follow-ups are routinely done by the hospital and patients are told to see their primary care provider if problems occur.