Just-in-Time Evidence-Based E-mail “Reminders” in Home Health Care: Impact on Patient Outcomes

Authors

  • Penny H. Feldman,

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    • Address correspondence to Penny H. Feldman, Ph.D., Director, Center for Home Care Policy & Research, Visiting Nurse Service of New York, 107 East 70th Street, New York, NY 10021. Christopher M. Murtaugh, Ph.D., Margaret V. McDonald, M.S.W., and Timothy R. Peng, Ph.D., are with the Center for Home Care Policy & Research, Visiting Nurse Service of New York. Liliana E. Pezzin, Ph.D., is with the Department of Medicine and Institute for Health Policy Studies, Medical College of Wisconsin.

  • Christopher M. Murtaugh,

  • Liliana E. Pezzin,

  • Margaret V. McDonald,

  • Timothy R. Peng


Abstract

Objective. To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients.

Data Sources/Study Setting. Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF.

Study Design. Patients were treated by nurses randomly assigned to usual care or one of two intervention groups. The basic intervention was an e-mail to the patient's nurse highlighting six HF-specific clinical recommendations. The augmented intervention supplemented the initial nurse reminder with additional clinician and patient resources.

Data Collection. Patient interviews were conducted 45 days post admission to measure self-management behaviors, HF-specific outcomes (Kansas City Cardiomyopathy Questionnaire-KCCQ), health-related quality of life (EuroQoL), and service use.

Principal Findings. Both interventions improved the mean KCCQ summary score (15.3 and 12.9 percent, respectively) relative to usual care (p≤.05). The basic intervention also yielded a higher EuroQoL score relative to usual care (p≤.05). In addition, the interventions had a positive impact on medication knowledge, diet, and weight monitoring. The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes.

Conclusions. This study demonstrates the positive impact of targeting evidence-based computer reminders to home health nurses to improve patient self-care behaviors, knowledge, and clinical outcomes. It also advances the field's limited understanding of the cost-effectiveness of selected strategies for translating research into practice.

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