For patients suffering from congestive heart failure, home care is an effective method for reducing rehospitalization rates and lowering care costs, writes a pair of researchers in the latest edition of Home Health Care Management and Practice.
"A primary diagnosis of heart failure accounts for over one million hospitalizations and a total Medicare expenditure exceeding US$17 billion annually," the article states. "In addition, discharge from a heart failure hospitalization is immediately followed by a readmission within 30 days in about 24% of cases." However, the researchers found that “an intensive home care surveillance program can prevent hospitalization and improve vital status in elderly patients with severe congestive heart failure.” Rates of compliance and patient independence also were found to increase under home care.
HOME CARE TEAM INVOLVEMENT IN OUTPATIENT TREATMENT
Sixty-eight congestive heart failure patients, each of whom had been enrolled in home care for a minimum of six months, were included in the study. All patients were visited at least once monthly by the same health care team, and the surveillance for each visit included a full medical assessment.
Additionally, the home health care team provided each patient with education on "heart failure pathophysiology, expected symptoms, diet changes (limiting sodium intake), monitoring activity level, limiting smoking and alcohol intake, maintaining a healthy weight, and other specific changes relevant to individual patients."
PATIENT IMPROVEMENT UNDER HOME CARE
The researchers garnered data for each patient during the time of home care, and included comparison parameters that extended to the six-month period before and after the initiation of home care services. They then compared the percentage of patients reporting symptoms experienced in the six months prior to home care visits to the percentage of patients who had the same symptoms after home care initiation:
• Average hospitalization rate decreased from 3.5 ± 0.3 hospitalizations/month to 0.8 ± 0.2 hospitalizations/month (p < .001; mean decrease of 2.8 hospitalizations/month).
• Paroxysmal nocturnal dyspnea and orthopnea decreased 31% (p < .001; 95% confidence interval [CI]).
• Dyspnea upon exertion decreased 37% (p < .001; 95% CI).
• Pedal edema decreased 27% (p < .001; 95% CI).
• Thirty-five patients became more compliant with instructions for medication regimen and diet restrictions "The major finding is that this type of care seems to decrease the number of hospitalizations," the researchers note. "Frequent [home care] visits and prompt delivery of medical care along with longterm patient/physician familiarity prevent delay in therapy, clinical progression of disease, and recurrent hospitalization."
Source: Maliakkal AV, Sun AZ. Home Care Program Reduces Hospital Readmissions in Patients with Congestive Hear t Failure and Improves Other Associated Indicators of Health. Home Health Care Manag Pract. 2014;26(4): 191-197.