Improving Heart Failure Care in Minority Communities
For congestive heart failure (CHF) patients with systolic dysfunction, a randomized controlled trial compared nurse-based disease management to address problems in patient and clinician management with usual care for effects on hospitalization and functioning among ethnically-diverse patients in ambulatory practices.
Congestive Heart Failure (CHF)
Behavioral: Nurse-based disease management
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Educational/Counseling/Training
|Official Title:||Improving Heart Failure Care in Minority Communities|
- All-cause hospitalizations and self-reported physical functioning as measured by the physical component score on the Short Form 12 questionnaire and Minnesota Living with Heart Failure Questionnaire.
- Costs and cost-effectiveness
|Study Start Date:||September 2000|
|Estimated Study Completion Date:||October 2003|
Congestive heart failure (CHF) disproportionately afflicts Black and elderly people, and is a leading cause of hospitalization > 65 years. Although effective therapies can improve functioning and survival in patients with systolic dysfunction, many may not be receiving the full benefit of existing knowledge, including counseling on self-management and appropriate doses of medications. Patients play a critical role in managing a chronic condition such as CHF, but may not have the skills to do so. Clinicians may not provide counseling or medications consistent with evidence-based guidelines.
Systematic reviews of clinical-behavior change have suggested that interventions targeted to specific problems are more likely to be successful. Based on shortfalls identified in patient self-management and clinical care in Harlem, a predominately non-white area in northern Manhattan, we tailored a nurse-management intervention to address the problems documented, and evaluated its effectiveness in a randomized controlled trial. This trial among primarily-minority patients addresses important gaps in this literature: the study targeted problems documented among CHF patients in Harlem, enrolled patients from ambulatory practices, randomly assigned patients between nurse-management and usual care, and evaluated their subsequent health-related outcomes. We hypothesized that the nurse-management program would result in nurse patients’ having fewer hospitalizations and reporting better functioning.
|United States, New York|
|Mount Sinai School of Medicine|
|New York, New York, United States, 10029-6574|
|New York, New York, United States, 10037|
|New York, New York, United States, 10029|
|North General Hospital|
|New York, New York, United States, 10035|
|Principal Investigator:||Jane Sisk, Ph.D.||Mount Sinai School of Medicine|