Medical center slashes CHF admissions by 51%
Medical center slashes CHF admissions by 51%
Officials credit pilot patient education project
Given the sheer magnitude of the problem of congestive heart failure (CHF), it’s no surprise that disease managers across the country are spending countless hours and dollars trying to improve care for patients and bring costs down. But it may be a surprise to know that, according to a new disease management study, one solution can be as quick and inexpensive as mailing patients information packets about their disease. (See story about designing an education packet, p. 127.)
A pilot patient education program that provided written and video materials to CHF patients at Columbia San Jose Medical Center in San Jose, CA, reduced hospital admissions for CHF by 51% in a six-month period, amounting to an estimated annual savings of $1.2 million in health care costs, says Monica Miyaji, BSN, quality improvement coordinator for the medical center and chief investigator of the study. The cost of the program was $50 per patient. But perhaps more importantly, the program led patients to make positive changes in behavior affecting their condition. For example, participants reported a 29% lower rate of salt intake and a 26% lower consumption of dietary fat compared with the control group. They reported overall improvements in health status and better compliance with doctors’ orders.
"A lot has happened in recent years in health care to cut staff and change the way we deliver care, and patient education has not been looked at as being the most important thing," Miyaji says. "If you expect patients to self-manage, you have to teach them how. The most important thing we can ever do is educate our patients."
Knowing how difficult it is to find time and money for extensive patient education, the researchers decided to test the results of offering a bare minimum program that would not add more to the plate of the bedside nurse. In fact, the nurses weren’t even told about the program so they wouldn’t change their normal education procedures. Half of the study’s 109 patients were mailed four informational packets over a 12-week period following their hospital discharge. The other half, who made up the control group, received nothing other than what the hospital would normally provide.
Patients were surveyed by telephone within two weeks of discharge. The survey tool was developed for the study and tested on a pilot group of 30 patients before the program began. (See survey, p. 126.) The questions probed baseline knowledge of the disease, such as eating habits and medication management. Twelve weeks later, the patients were asked to answer the same questions.
Krames Communications, a San Bruno, CA-based publisher of consumer-oriented medical and wellness materials, provided the materials for the packets. Topics included low-salt eating, making choices at restaurants, the importance of daily weight checks, activity levels, common medications and how to manage them, and general health care information not specific to CHF such as coping with stress and identifying depression. One popular item included was an accordion folder labeled "important health care information" that gave patients a place to keep all their health care papers together. Patients also received a Krames video that uses computer animation to show what CHF does to the heart.
Miyaji says that while the materials used in the study were excellent, it doesn’t matter so much what materials you use as long as patients get some reinforcement. "Awareness, skill-building, and reinforcement are the three things we need to provide patients so they can change their behavior," she says. "We in health care do a great job at awareness, but we fall short on the follow-up.
"The bottom line is that you can do this type of program if nothing else," Miyaji says. "Of course, you could improve your results even more by adding personal intervention, but this study shows you don’t have to spend a lot of money to make a difference. You can put this strategy in the middle of any CHF program and make it work for you."
[For more information on CHF patient education, contact: Monica Miyaji, BSN, quality improvement coordinator, Columbia San Jose Medical Center, 675 E. Santa Clara St., San Jose, CA. 95154-2403. Telephone: (408) 977-7363.]
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