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Palliative Care, Quality of Life, and Depression in Persons with Heart Failure
Abstracts / Heart & Lung 43 (2014) 373e378
LVAD patients following surgery, creating a need for improved engagement during the post-operative course. In an effort to enhance a youthful program, focus is being placed on how to maximize LVAD patient engagement in order to more efficiently prepare them for life after discharge. Due to the nature of LVAD technology and post-implantation requirements for care, full participation in multidisciplinary therapies and self-care education are crucial for patients in the LVAD population to survive. Consequently, Scripps Memorial Hospital requires successful completion of a comprehensive LVAD exam for patients to be considered ready for discharge from the hospital. Our objective is to determine the effect of a multidisciplinary instruction tool on motivation and depression in the LVAD patient immediately post-implantation. Methods: Reports in the literature suggest that newly-implanted LVAD patients experience increased depression and reduced motivation levels. Therefore, the Patient Health Questionnaire (PHQ-9) will be administered at predetermined intervals throughout the course of the hospital stay, and will help to establish a relationship, if any, between the implementation of the new intervention and patient depression levels. Two Advanced Practice Nurses developed an interdisciplinary instruction tool specific to the LVAD patient immediately post-implantation. The instruction tool, known to the developers as a “care board,” clearly communicates the LVAD patient’s expected recovery goals at various stages throughout the patient’s post-implantation course, while allowing for collaboration of all disciplines to accomplish the unified goal of patient discharge. We are performing a longitudinal, quantitative research study to identify how use of interdisciplinary instruction tools (“care boards”) will affect motivation and depression in the post-implant patient. The effects will be measured by number of days to passing LVAD exam and patient depression level according to the PHQ-9. Results: The results of this study, to be analyzed at the end of the 1-year trial period in February, 2015, will be reportable at that time. Anticipated results include improved PHQ-9 scores and decreased number of days to passing of the LVAD exam, as well as decreased depression symptoms and increased motivation as reported by multidisciplinary staff. Conclusion: The conclusion will be based on results to be calculated in February, 2015. Results will largely impact the LVAD care plan.
11 Palliative Care, Quality of Life, and Depression in Persons with Heart Failure SHARON VINCENT 1, SANJEEV GULATI 2, DEBORAH FENNER 2, STEPHANIE WOODS 1 1 University North Carolina at Charlotte 2 Carolinas Healthcare System Background: Persons with heart failure face a unique trajectory of illness characterized by periods of stability and episodes of acute exacerbations. Heart failure patients face multidimensional challenges involving physical health and psychosocial wellbeing (Bailey et al., 2011) and terminal phases are difficult to predict. Palliative care, a person-centered interdisciplinary approach to easing symptoms and improving quality of life, is often combined with other established treatment programs such as transition to care. However, there is a paucity of research exploring palliative care in combination with transition to care programs as a means of meeting the unique multidimensional needs of persons with heart failure, a gap this project begins to address. Methods: The purpose of this research project was to: (a) examine differences in quality of life, depression, heart failure symptoms, and re-hospitalizations in persons participating in a usual care 4-week transition to care program following hospitalization for heart failure compared to those participating in a 4-week transition to care program along with palliative care intervention, and (b)
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identify the combination of demographics, health variables, palliative care, depression, and symptoms that uniquely predicted quality of life in persons with heart failure. The 4-week transition to care program is an education and support program designed specifically for heart failure patients and is comprised of a multidisciplinary team. Patients attended the clinic once a week for four weeks and received evidence-based interventions and palliative care aimed at heart failure. Results: This research project used a comparativeepredictive design. A convenience sample of 102 participants was recruited from a major Healthcare System in North Carolina who had a diagnosis of primary heart failure. Fifty-one persons who participated in a 4week transition to care plus palliative care program following hospitalization for heart failure were recruited. A group of 51 persons matched on age, gender, race/ethnicity, and severity of illness who participated in the usual care 4-week transition to care program, but did not have the palliative care intervention, was obtained for comparison. The sample size of 102 participants had a power of 0.80 with a medium effect size and probability of 0.05. Quality of life, depression, heart failure symptoms, and re-hospitalization were measured. The Minnesota Living with Heart Failure Questionnaire, a 21 item, 6-point Likert scale, was used to evaluate quality of life including physical symptoms and emotional distress. The Patient Health Questionnaire, a 9 item, 6-point Likert scale, was used to assess depression. Both of these measures were collected before entering the 4-week program and upon completion of the program. Heart failure symptoms, re-hospitalizations, demographic and health variables were collected via chart review. Analyses consisted of t-tests, correlations, and a series of regression equations. Conclusion: Findings provide preliminary evaluation for adding palliative care interventions to a 4-week transition to care program that improves quality of life and decreases depression and rehospitalizations in persons with heart failure.
12 Decreasing Readmissions: Success or Failure LISA HENRY, JANET GRIFFIN, LAURA DOXAKIS, AMY LITWINOVICH West Virginia University Hospital Background: Program Structure and Population The purpose of this abstract is to summarize our journey of adopting a multidisciplinary collaborative team led by a nurse practitioner and its effect on West Virginia University Hospital’s heart failure readmission rates. West Virginia University Hospital is a rural 531-bed tertiary care referral center and serves as the primary teaching destination for West Virginia University’s health professions schools. According to the National Vital Statistics Report, 2009, more than 1 out of 4 deaths in West Virginia were due to heart disease (25.7 percent of total deaths). Strategies Our strategies have included extensive one-on-one education with the nurse practitioner while in the hospital and having a follow up appointments with her, teach back evaluation, medication reconciliation, personalized phone calls, a nurse practitioner led collaborative team meeting daily to discuss the patients and to set realistic goals for care, out-patient diuresis clinic, remote device/impedance monitoring and a free Lifestyle Enhancement program. Methods: Data Collection and Evaluation Our performance improvement initiative was based on meeting Quality BLUE and GWTG outcomes and decreasing all cause readmissions for heart failure patients. Peer group review of each readmission is conducted to determine if there are any identifiable institutional factors that may have impeded our success and to look at scores of managing readmissions for primary heart failure. Results: Outcomes The data collected includes readmission rates for actual heart failure and all-cause. In 2012, our all-cause readmission was 27.32% with 10.82% being for heart failure specifically. In 2013, our all-cause readmission decreased to 20.23% with a
LVAD patients following surgery, creating a need for improved engagement during the post-operative course. In an effort to enhance a youthful program, focus is being placed on how to maximize LVAD patient engagement in order to more efficiently prepare them for life after discharge. Due to the nature of LVAD technology and post-implantation requirements for care, full participation in multidisciplinary therapies and self-care education are crucial for patients in the LVAD population to survive. Consequently, Scripps Memorial Hospital requires successful completion of a comprehensive LVAD exam for patients to be considered ready for discharge from the hospital. Our objective is to determine the effect of a multidisciplinary instruction tool on motivation and depression in the LVAD patient immediately post-implantation. Methods: Reports in the literature suggest that newly-implanted LVAD patients experience increased depression and reduced motivation levels. Therefore, the Patient Health Questionnaire (PHQ-9) will be administered at predetermined intervals throughout the course of the hospital stay, and will help to establish a relationship, if any, between the implementation of the new intervention and patient depression levels. Two Advanced Practice Nurses developed an interdisciplinary instruction tool specific to the LVAD patient immediately post-implantation. The instruction tool, known to the developers as a “care board,” clearly communicates the LVAD patient’s expected recovery goals at various stages throughout the patient’s post-implantation course, while allowing for collaboration of all disciplines to accomplish the unified goal of patient discharge. We are performing a longitudinal, quantitative research study to identify how use of interdisciplinary instruction tools (“care boards”) will affect motivation and depression in the post-implant patient. The effects will be measured by number of days to passing LVAD exam and patient depression level according to the PHQ-9. Results: The results of this study, to be analyzed at the end of the 1-year trial period in February, 2015, will be reportable at that time. Anticipated results include improved PHQ-9 scores and decreased number of days to passing of the LVAD exam, as well as decreased depression symptoms and increased motivation as reported by multidisciplinary staff. Conclusion: The conclusion will be based on results to be calculated in February, 2015. Results will largely impact the LVAD care plan.
11 Palliative Care, Quality of Life, and Depression in Persons with Heart Failure SHARON VINCENT 1, SANJEEV GULATI 2, DEBORAH FENNER 2, STEPHANIE WOODS 1 1 University North Carolina at Charlotte 2 Carolinas Healthcare System Background: Persons with heart failure face a unique trajectory of illness characterized by periods of stability and episodes of acute exacerbations. Heart failure patients face multidimensional challenges involving physical health and psychosocial wellbeing (Bailey et al., 2011) and terminal phases are difficult to predict. Palliative care, a person-centered interdisciplinary approach to easing symptoms and improving quality of life, is often combined with other established treatment programs such as transition to care. However, there is a paucity of research exploring palliative care in combination with transition to care programs as a means of meeting the unique multidimensional needs of persons with heart failure, a gap this project begins to address. Methods: The purpose of this research project was to: (a) examine differences in quality of life, depression, heart failure symptoms, and re-hospitalizations in persons participating in a usual care 4-week transition to care program following hospitalization for heart failure compared to those participating in a 4-week transition to care program along with palliative care intervention, and (b)
377
identify the combination of demographics, health variables, palliative care, depression, and symptoms that uniquely predicted quality of life in persons with heart failure. The 4-week transition to care program is an education and support program designed specifically for heart failure patients and is comprised of a multidisciplinary team. Patients attended the clinic once a week for four weeks and received evidence-based interventions and palliative care aimed at heart failure. Results: This research project used a comparativeepredictive design. A convenience sample of 102 participants was recruited from a major Healthcare System in North Carolina who had a diagnosis of primary heart failure. Fifty-one persons who participated in a 4week transition to care plus palliative care program following hospitalization for heart failure were recruited. A group of 51 persons matched on age, gender, race/ethnicity, and severity of illness who participated in the usual care 4-week transition to care program, but did not have the palliative care intervention, was obtained for comparison. The sample size of 102 participants had a power of 0.80 with a medium effect size and probability of 0.05. Quality of life, depression, heart failure symptoms, and re-hospitalization were measured. The Minnesota Living with Heart Failure Questionnaire, a 21 item, 6-point Likert scale, was used to evaluate quality of life including physical symptoms and emotional distress. The Patient Health Questionnaire, a 9 item, 6-point Likert scale, was used to assess depression. Both of these measures were collected before entering the 4-week program and upon completion of the program. Heart failure symptoms, re-hospitalizations, demographic and health variables were collected via chart review. Analyses consisted of t-tests, correlations, and a series of regression equations. Conclusion: Findings provide preliminary evaluation for adding palliative care interventions to a 4-week transition to care program that improves quality of life and decreases depression and rehospitalizations in persons with heart failure.
12 Decreasing Readmissions: Success or Failure LISA HENRY, JANET GRIFFIN, LAURA DOXAKIS, AMY LITWINOVICH West Virginia University Hospital Background: Program Structure and Population The purpose of this abstract is to summarize our journey of adopting a multidisciplinary collaborative team led by a nurse practitioner and its effect on West Virginia University Hospital’s heart failure readmission rates. West Virginia University Hospital is a rural 531-bed tertiary care referral center and serves as the primary teaching destination for West Virginia University’s health professions schools. According to the National Vital Statistics Report, 2009, more than 1 out of 4 deaths in West Virginia were due to heart disease (25.7 percent of total deaths). Strategies Our strategies have included extensive one-on-one education with the nurse practitioner while in the hospital and having a follow up appointments with her, teach back evaluation, medication reconciliation, personalized phone calls, a nurse practitioner led collaborative team meeting daily to discuss the patients and to set realistic goals for care, out-patient diuresis clinic, remote device/impedance monitoring and a free Lifestyle Enhancement program. Methods: Data Collection and Evaluation Our performance improvement initiative was based on meeting Quality BLUE and GWTG outcomes and decreasing all cause readmissions for heart failure patients. Peer group review of each readmission is conducted to determine if there are any identifiable institutional factors that may have impeded our success and to look at scores of managing readmissions for primary heart failure. Results: Outcomes The data collected includes readmission rates for actual heart failure and all-cause. In 2012, our all-cause readmission was 27.32% with 10.82% being for heart failure specifically. In 2013, our all-cause readmission decreased to 20.23% with a