Telehealth Self Management for CHF
| Status: | Completed |
|---|---|
| Conditions: | Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 55 - 85 |
| Updated: | 2/7/2015 |
| Start Date: | November 2014 |
| End Date: | October 2015 |
| Contact: | Charlene A Pope, PhD MPH BSN |
| Email: | Charlene.Pope@va.gov |
| Phone: | (843) 789-6577 |
Communication Skills Training for Heart Failure Self-Management in Telehealth
People with heart failure (HF) are hospitalized over a million times a year in the US at a
cost over $39 billion dollars. About half of the patients are readmitted within 30 days.
Despite a number of institutional reforms, cost and readmissions remain high in the VA. The
VA Home Telehealth (HT) monitoring program decreases preventable readmissions, but HF
readmissions remain increased in the VA. Despite an active and effective HT program, the
Charleston VAMC has the highest HF readmission rate in VISN 7. Though the HT program
introduces communication, self-management, and shared decision-making in initial training,
previous QUERI RRP evaluation identified lower than expected levels of specific
communication practices associated with the promotion of HF self-management and shared
decision-making, mediated by the requirements of the technology.
cost over $39 billion dollars. About half of the patients are readmitted within 30 days.
Despite a number of institutional reforms, cost and readmissions remain high in the VA. The
VA Home Telehealth (HT) monitoring program decreases preventable readmissions, but HF
readmissions remain increased in the VA. Despite an active and effective HT program, the
Charleston VAMC has the highest HF readmission rate in VISN 7. Though the HT program
introduces communication, self-management, and shared decision-making in initial training,
previous QUERI RRP evaluation identified lower than expected levels of specific
communication practices associated with the promotion of HF self-management and shared
decision-making, mediated by the requirements of the technology.
Clinical goals of the VA CHF QUERI identify best practices to empower Veterans and their
caregivers for HF self-management. Recommendations of the American College of
Cardiology/American Heart Association emphasize shared decision-making. In the previous
preliminary study, coding of actual recordings of Veterans speaking with HT nurse care
coordinators provided evidence of best practices and areas for improvement for intervention
development. The effect of the HT technology as a mediator of Veteran-nurse communication
requires particular re-framing in communication skills training to promote shared
decision-making and self-management as recommended. This quasi-experimental study proposes
the development of an evidence-based intervention to enhance HT training tailored for more
effective communication for HF self-management and related outcomes.
Goals:
Phase 1 To conduct a pilot study as a quasi-experimental trial at two VAMC HT sites to
determine acceptability, actual use, implementation, practicality, integration, potential
for expansion, effect sizes and limited efficacy for an HT-specific communication skills
intervention for HF Specific Aim 1.1a Development: Adapt components from the Rochester
Participatory Decision-Making Scale (RPAD) and recent advances in communication skills
training for chronic disease to develop a valid and reliable intervention specific to HT
shared decision-making and telehealth communication using established best-practices and
Veteran input; Specific Aim 1.1b Training/Implementation: Implement the developed
intervention at two VAMCs; Specific Aim 1.2Booster: Introduce an audit and feedback loop of
HF self-management outcomes for telehealth nurse practice as a booster to reinforce
communication skills training.
Phase 2 To compare changes in Veteran outcomes after a telehealth communication skills
intervention with documented previous practice for differences in: a) shared
decision-making; b) Veteran perception of communication, education and self-management for
HF, c) quality of life, and d) health service utilization and related costs before and after
intervention Specific Aim 2.1: Formative Evaluation: Nurses: Conduct anonymous surveys of
knowledge of HF and self-management strategies before and after training, qualitative
interviews of reactions to the training course, and nurse care coordinator focus groups
about the value of audit and feedback sessions after training.
Specific Aim 2.2: Formative Evaluation: Veterans - Phone record 25 Veterans with HF at two
HT sites, for a total of 50 Veterans, speaking with nurse care coordinators before and after
communication skills training followed by communication coding and discourse analysis.
Specific Aim 2.3: Summative Evaluation: Compare shared decision-making scores (SDM) measured
by the RPAD, communication scores measured by the Four Habits Coding Scheme (FHCS), quality
of life (Minnesota Living with Heart Failure Questionnaire), communication, education and
self-management in HF as measured by the Improving Chronic Illness Care Evaluation (ICICE)
scale, and patient HF hospitalization use (admissions and emergency) and with pre-training
averages and with the post training averages at 1 and 3 months Rationale The technology of
HT monitoring of Veterans with HF can inadvertently decrease participative communication
consistent with shared decision-making and HF self-management. Application of communication
skills training using evidence-based coach role competencies promises to improve Veteran
engagement and participation in the VA Home Telehealth service with increased
self-management and potential improvement in HF health service utilization. Improving
engagement and participation in self-management should result in a quantifiably better
Veteran quality of life, a reduction in hospital and ED admissions, and thus, a decrease in
health care utilization costs for the VA.
caregivers for HF self-management. Recommendations of the American College of
Cardiology/American Heart Association emphasize shared decision-making. In the previous
preliminary study, coding of actual recordings of Veterans speaking with HT nurse care
coordinators provided evidence of best practices and areas for improvement for intervention
development. The effect of the HT technology as a mediator of Veteran-nurse communication
requires particular re-framing in communication skills training to promote shared
decision-making and self-management as recommended. This quasi-experimental study proposes
the development of an evidence-based intervention to enhance HT training tailored for more
effective communication for HF self-management and related outcomes.
Goals:
Phase 1 To conduct a pilot study as a quasi-experimental trial at two VAMC HT sites to
determine acceptability, actual use, implementation, practicality, integration, potential
for expansion, effect sizes and limited efficacy for an HT-specific communication skills
intervention for HF Specific Aim 1.1a Development: Adapt components from the Rochester
Participatory Decision-Making Scale (RPAD) and recent advances in communication skills
training for chronic disease to develop a valid and reliable intervention specific to HT
shared decision-making and telehealth communication using established best-practices and
Veteran input; Specific Aim 1.1b Training/Implementation: Implement the developed
intervention at two VAMCs; Specific Aim 1.2Booster: Introduce an audit and feedback loop of
HF self-management outcomes for telehealth nurse practice as a booster to reinforce
communication skills training.
Phase 2 To compare changes in Veteran outcomes after a telehealth communication skills
intervention with documented previous practice for differences in: a) shared
decision-making; b) Veteran perception of communication, education and self-management for
HF, c) quality of life, and d) health service utilization and related costs before and after
intervention Specific Aim 2.1: Formative Evaluation: Nurses: Conduct anonymous surveys of
knowledge of HF and self-management strategies before and after training, qualitative
interviews of reactions to the training course, and nurse care coordinator focus groups
about the value of audit and feedback sessions after training.
Specific Aim 2.2: Formative Evaluation: Veterans - Phone record 25 Veterans with HF at two
HT sites, for a total of 50 Veterans, speaking with nurse care coordinators before and after
communication skills training followed by communication coding and discourse analysis.
Specific Aim 2.3: Summative Evaluation: Compare shared decision-making scores (SDM) measured
by the RPAD, communication scores measured by the Four Habits Coding Scheme (FHCS), quality
of life (Minnesota Living with Heart Failure Questionnaire), communication, education and
self-management in HF as measured by the Improving Chronic Illness Care Evaluation (ICICE)
scale, and patient HF hospitalization use (admissions and emergency) and with pre-training
averages and with the post training averages at 1 and 3 months Rationale The technology of
HT monitoring of Veterans with HF can inadvertently decrease participative communication
consistent with shared decision-making and HF self-management. Application of communication
skills training using evidence-based coach role competencies promises to improve Veteran
engagement and participation in the VA Home Telehealth service with increased
self-management and potential improvement in HF health service utilization. Improving
engagement and participation in self-management should result in a quantifiably better
Veteran quality of life, a reduction in hospital and ED admissions, and thus, a decrease in
health care utilization costs for the VA.
Inclusion Criteria:
- diagnosis of chronic heart failure (CHF)
- enrollment in VA Home Telehealth (HT) program for at least 6 months
- Veteran who did not participate in the previous HT study
Exclusion Criteria:
- Veteran who is unable to communicate by telephone
- Veteran who does not pass the Clock Drawing Test for screening neurological problems
at the initial visit
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