- Email: [email protected]
17. Health literacy influences knowledge attainment but not self-care or self-efficacy longitudinally in patients with heart failure
h e a r t & l u n g 4 1 ( 2 0 1 2 ) 4 1 1 e4 2 0
Daily Activity Questionnaire in Heart Failure (DAQIHF), Charleson Co-morbidity Index, and device-based Activity Log Index (ALI). A convenience sample of 28 heart failure patients were recruited from an urban academic center and a suburban private practice. Results: Subjects (64% male, mean age ¼ 63 +/- 14 years, 57% Caucasian, mean LVEF¼ 29% +/- 12%) reported majority of time spent in low levels of daily physical activity at both baseline and post-CRT (mean ¼ 82.2 +/20.5%). There was a 333% reported increase in time spent on high levels of daily physical activity (p ¼ 0.019) post-CRT. 6MW distance improved 28% from baseline to 3 months post-implantation (p <.0001). The ALI detected a mean of 9.7% +/- 5.4% time (approximately 2.3 hours) in daily physical activity. Though subjective findings from the DAQIHF did not correlate with the objective findings of the ALI, the ALI significantly correlated with the postCRT 6MW distance (r ¼ 0.63, p ¼ 0.004). Conclusion: CRT patients were found to improve high levels of daily physical activity and physical function at 3 months post-CRT, but continued to spend majority of time in low levels of physical activity. Further study is recommended to explore whether or not cardiac rehabilitation programming is indicated.
16. Hospitalization and rehospitalization rates of patients in a network of nurse-led heart failure clinics D. Walker, Chronic Care Services, Euclid Hospital, Euclid, OH, A.F. Jacobson, V. Sumodi, Chronic Care Services, Hillcrest Hospital, Mayfield Heights, OH Purpose: This study examined the frequency of hospital admissions and readmissions in persons with heart failure (HF) receiving care at 4 nurse-led HF clinics. Background: HF is the leading cause of hospitalization in adults 65 and over, and hospitalization for HF is associated with increased morbidity and mortality. Nationally, almost 1/3 of heart failure patients are readmitted within 30 days of discharge. The Chronic Care Model provides a framework for care in a regional network of nurse-led ambulatory HF clinics aimed at promoting patient self-management and care coordination to reduce hospitalization and re-hospitalization rates of persons with HF. Advanced practice nurses and registered nurses, guided by standardized order sets based on the 2009 AHA/ACC Heart Failure Guidelines, promote patient self-management through exercise, sodium restriction, medication reconciliation and adherence, and self-monitoring. Data are recorded in an electronic medical record (EMR), with select variables deposited in a clinical data registry linked to hospitalization data. Methods: Data recorded since the clinics instituted the EMR in 2008 through February 2012 were abstracted from the electronic registry of data collected during patient visits at the outpatient HF clinics of four
419
community hospitals in Northeast Ohio. Hospital discharge data included number of admissions and primary discharge diagnosis form the hospital EMR. Patients who were admitted to a HF clinic with a diagnosis of systolic or diastolic heart failure and had 2 or more visits were included. Of the 799 patients meeting these criteria, mean age was 72 years, 54 percent were male, and 50 percent had systolic heart failure. Results: Of the 799 patients included in the study, 45 percent experienced at least 1 hospitalization. The leading cause of admission was heart failure (42%), followed by acute kidney failure (12%). Of those who were discharged with a HF diagnosis, only 6% were readmitted within 30 days, in contrast to the average 30-day HF readmission rate of 24% for the region. We found insufficient (missing) data in the EMR on factors such as functional status (SF-12 and 6-minute walk) and NYHA Class to compare among groups. Conclusion: Results from this study, although derived from a retrospective, nonrandomized chart review, suggest that patients in a nurse-led HF clinic may experience less frequent 30-day hospital readmissions after being discharged with a diagnosis of heart failure than the regional population. The overall hospital admission rate of 45% in our population may be a reflection of this group’s greater vulnerability, since they are selectively referred by primary care or cardiology providers. More research is needed to determine factors contributing to hospital admission and readmission in this population. We found low rates of recording data on such variables as NYHA classification, quality of life and functional status in the EMR, possibly because these data must be manually entered by nursing staff, who were newly introduced to the electronic record during the time of this study. Evidence-based approaches to achieve more complete EMR documentation to enable further study of factors contributing to hospitalization are planned.
17. Health literacy influences knowledge attainment but not self-care or self-efficacy longitudinally in patients with heart failure K.S. Yehle, Nursing, Purdue University, West Lafayette, IN, A.M. Chen, Pharmacy, Cedarville University, Cedarville, OH, N.M. Albert, Nursing, Cleveland Clinic, Cleveland, OH, K.F. Ferraro, Sociology, Purdue University, West Lafayette, IN, H.L. Mason, M.M. Murawski, K.S. Plake, Pharmacy, Purdue University, West Lafayette, IN Purpose: The objective of this study was to examine health literacy, knowledge, self-efficacy, and self-care longitudinally in heart failure. It is hypothesized that patient health literacy level will be associated with differential gains in knowledge, self-efficacy, and selfcare after completion of traditional clinic-based education.
420
h e a r t & l u n g 4 1 ( 2 0 1 2 ) 4 1 1 e4 2 0
Background: Inadequate health literacy may be a barrier during traditional clinic-based heart failure education. The influence of health literacy on gains over time in knowledge, self-efficacy and self-care is unknown. Methods: First-time patients at 3 heart failure clinics (N¼51, age: 64.713.04 years) completed assessments of health literacy (Short-Form Test of Functional Health Literacy in Adults), knowledge (Heart Failure Knowledge Questionnaire), and selfcare/self-efficacy (Self-Care of Heart Failure Index v.6) prior to receiving heart failure education (baseline), at 2 months (education completion), and at 4 months post-baseline. Repeated measures Analysis of Variance was used to analyze longitudinal associations, and post-hoc tests with Bonferroni-adjusted alpha-levels were used for comparison. Results: Higher health literacy was associated with greater heart failure knowledge at 2 and 4
months (p<0.001), but there were no associations between health literacy and self-care or self-efficacy. In post-hoc analyses, patients with inadequate health literacy had less knowledge than those with marginal (p¼0.024) or adequate (p<0.001) health literacy at 2 months. At 4 months, patients with inadequate health literacy continued to have less knowledge compared to those with adequate health literacy (p<0.001). Conclusion: Health literacy level is associated with attaining and retaining heart failure knowledge; however, it is not associated with self-care confidence or adherence. Tailoring heart failure education to health literacy level may aid in grasping concepts taught. It is unknown if a better grasp of concepts would enhance self-care adherence and promote improved health. Future research is needed to more fully understand the consequences of inadequate health literacy on self-care.
Daily Activity Questionnaire in Heart Failure (DAQIHF), Charleson Co-morbidity Index, and device-based Activity Log Index (ALI). A convenience sample of 28 heart failure patients were recruited from an urban academic center and a suburban private practice. Results: Subjects (64% male, mean age ¼ 63 +/- 14 years, 57% Caucasian, mean LVEF¼ 29% +/- 12%) reported majority of time spent in low levels of daily physical activity at both baseline and post-CRT (mean ¼ 82.2 +/20.5%). There was a 333% reported increase in time spent on high levels of daily physical activity (p ¼ 0.019) post-CRT. 6MW distance improved 28% from baseline to 3 months post-implantation (p <.0001). The ALI detected a mean of 9.7% +/- 5.4% time (approximately 2.3 hours) in daily physical activity. Though subjective findings from the DAQIHF did not correlate with the objective findings of the ALI, the ALI significantly correlated with the postCRT 6MW distance (r ¼ 0.63, p ¼ 0.004). Conclusion: CRT patients were found to improve high levels of daily physical activity and physical function at 3 months post-CRT, but continued to spend majority of time in low levels of physical activity. Further study is recommended to explore whether or not cardiac rehabilitation programming is indicated.
16. Hospitalization and rehospitalization rates of patients in a network of nurse-led heart failure clinics D. Walker, Chronic Care Services, Euclid Hospital, Euclid, OH, A.F. Jacobson, V. Sumodi, Chronic Care Services, Hillcrest Hospital, Mayfield Heights, OH Purpose: This study examined the frequency of hospital admissions and readmissions in persons with heart failure (HF) receiving care at 4 nurse-led HF clinics. Background: HF is the leading cause of hospitalization in adults 65 and over, and hospitalization for HF is associated with increased morbidity and mortality. Nationally, almost 1/3 of heart failure patients are readmitted within 30 days of discharge. The Chronic Care Model provides a framework for care in a regional network of nurse-led ambulatory HF clinics aimed at promoting patient self-management and care coordination to reduce hospitalization and re-hospitalization rates of persons with HF. Advanced practice nurses and registered nurses, guided by standardized order sets based on the 2009 AHA/ACC Heart Failure Guidelines, promote patient self-management through exercise, sodium restriction, medication reconciliation and adherence, and self-monitoring. Data are recorded in an electronic medical record (EMR), with select variables deposited in a clinical data registry linked to hospitalization data. Methods: Data recorded since the clinics instituted the EMR in 2008 through February 2012 were abstracted from the electronic registry of data collected during patient visits at the outpatient HF clinics of four
419
community hospitals in Northeast Ohio. Hospital discharge data included number of admissions and primary discharge diagnosis form the hospital EMR. Patients who were admitted to a HF clinic with a diagnosis of systolic or diastolic heart failure and had 2 or more visits were included. Of the 799 patients meeting these criteria, mean age was 72 years, 54 percent were male, and 50 percent had systolic heart failure. Results: Of the 799 patients included in the study, 45 percent experienced at least 1 hospitalization. The leading cause of admission was heart failure (42%), followed by acute kidney failure (12%). Of those who were discharged with a HF diagnosis, only 6% were readmitted within 30 days, in contrast to the average 30-day HF readmission rate of 24% for the region. We found insufficient (missing) data in the EMR on factors such as functional status (SF-12 and 6-minute walk) and NYHA Class to compare among groups. Conclusion: Results from this study, although derived from a retrospective, nonrandomized chart review, suggest that patients in a nurse-led HF clinic may experience less frequent 30-day hospital readmissions after being discharged with a diagnosis of heart failure than the regional population. The overall hospital admission rate of 45% in our population may be a reflection of this group’s greater vulnerability, since they are selectively referred by primary care or cardiology providers. More research is needed to determine factors contributing to hospital admission and readmission in this population. We found low rates of recording data on such variables as NYHA classification, quality of life and functional status in the EMR, possibly because these data must be manually entered by nursing staff, who were newly introduced to the electronic record during the time of this study. Evidence-based approaches to achieve more complete EMR documentation to enable further study of factors contributing to hospitalization are planned.
17. Health literacy influences knowledge attainment but not self-care or self-efficacy longitudinally in patients with heart failure K.S. Yehle, Nursing, Purdue University, West Lafayette, IN, A.M. Chen, Pharmacy, Cedarville University, Cedarville, OH, N.M. Albert, Nursing, Cleveland Clinic, Cleveland, OH, K.F. Ferraro, Sociology, Purdue University, West Lafayette, IN, H.L. Mason, M.M. Murawski, K.S. Plake, Pharmacy, Purdue University, West Lafayette, IN Purpose: The objective of this study was to examine health literacy, knowledge, self-efficacy, and self-care longitudinally in heart failure. It is hypothesized that patient health literacy level will be associated with differential gains in knowledge, self-efficacy, and selfcare after completion of traditional clinic-based education.
420
h e a r t & l u n g 4 1 ( 2 0 1 2 ) 4 1 1 e4 2 0
Background: Inadequate health literacy may be a barrier during traditional clinic-based heart failure education. The influence of health literacy on gains over time in knowledge, self-efficacy and self-care is unknown. Methods: First-time patients at 3 heart failure clinics (N¼51, age: 64.713.04 years) completed assessments of health literacy (Short-Form Test of Functional Health Literacy in Adults), knowledge (Heart Failure Knowledge Questionnaire), and selfcare/self-efficacy (Self-Care of Heart Failure Index v.6) prior to receiving heart failure education (baseline), at 2 months (education completion), and at 4 months post-baseline. Repeated measures Analysis of Variance was used to analyze longitudinal associations, and post-hoc tests with Bonferroni-adjusted alpha-levels were used for comparison. Results: Higher health literacy was associated with greater heart failure knowledge at 2 and 4
months (p<0.001), but there were no associations between health literacy and self-care or self-efficacy. In post-hoc analyses, patients with inadequate health literacy had less knowledge than those with marginal (p¼0.024) or adequate (p<0.001) health literacy at 2 months. At 4 months, patients with inadequate health literacy continued to have less knowledge compared to those with adequate health literacy (p<0.001). Conclusion: Health literacy level is associated with attaining and retaining heart failure knowledge; however, it is not associated with self-care confidence or adherence. Tailoring heart failure education to health literacy level may aid in grasping concepts taught. It is unknown if a better grasp of concepts would enhance self-care adherence and promote improved health. Future research is needed to more fully understand the consequences of inadequate health literacy on self-care.