Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial

Authors

  • Mary D. Naylor PhD,

    1. From the *Gerontological Nursing Science Center, School of Nursing, Leonard Davis Institute of Health Economics, Department of Medicine, School of Medicine, and §Health Care Systems Department, Wharton School, University of Pennsylvania, Philadelphia, PennsylvaniaSchool of Nursing, Florida International University, Miami, FloridaBiomedical Statistical Consulting, Wynnewood, Pennsylvania.
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  • Dorothy A. Brooten PhD,

    1. From the *Gerontological Nursing Science Center, School of Nursing, Leonard Davis Institute of Health Economics, Department of Medicine, School of Medicine, and §Health Care Systems Department, Wharton School, University of Pennsylvania, Philadelphia, PennsylvaniaSchool of Nursing, Florida International University, Miami, FloridaBiomedical Statistical Consulting, Wynnewood, Pennsylvania.
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  • Roberta L. Campbell PhD,

    1. From the *Gerontological Nursing Science Center, School of Nursing, Leonard Davis Institute of Health Economics, Department of Medicine, School of Medicine, and §Health Care Systems Department, Wharton School, University of Pennsylvania, Philadelphia, PennsylvaniaSchool of Nursing, Florida International University, Miami, FloridaBiomedical Statistical Consulting, Wynnewood, Pennsylvania.
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  • Greg Maislin MS, MA,

    1. From the *Gerontological Nursing Science Center, School of Nursing, Leonard Davis Institute of Health Economics, Department of Medicine, School of Medicine, and §Health Care Systems Department, Wharton School, University of Pennsylvania, Philadelphia, PennsylvaniaSchool of Nursing, Florida International University, Miami, FloridaBiomedical Statistical Consulting, Wynnewood, Pennsylvania.
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  • Kathleen M. McCauley PhD,

    1. From the *Gerontological Nursing Science Center, School of Nursing, Leonard Davis Institute of Health Economics, Department of Medicine, School of Medicine, and §Health Care Systems Department, Wharton School, University of Pennsylvania, Philadelphia, PennsylvaniaSchool of Nursing, Florida International University, Miami, FloridaBiomedical Statistical Consulting, Wynnewood, Pennsylvania.
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  • J. Sanford Schwartz MD

    1. From the *Gerontological Nursing Science Center, School of Nursing, Leonard Davis Institute of Health Economics, Department of Medicine, School of Medicine, and §Health Care Systems Department, Wharton School, University of Pennsylvania, Philadelphia, PennsylvaniaSchool of Nursing, Florida International University, Miami, FloridaBiomedical Statistical Consulting, Wynnewood, Pennsylvania.
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  • The National Institute for Nursing Research, National Institutes of Health funded this study (Grant 1RO1-NR04315, Dr. Mary D. Naylor, Principal Investigator).

  • Preliminary results were presented at the 6th Annual Scientific Meeting of the Heart Failure Society of America, Boca Raton, Florida, September 23, 2002.

Address correspondence to Mary D. Naylor, PhD, RN, FAAN, Marian S. Ware Professor in Gerontology, University of Pennsylvania, School of Nursing, 420 Guardian Drive, Philadelphia, PA 19104. E-mail: naylor@nursing.upenn.edu

Abstract

Objectives: To examine the effectiveness of a transitional care intervention delivered by advanced practice nurses (APNs) to elders hospitalized with heart failure.

Design: Randomized, controlled trial with follow-up through 52 weeks postindex hospital discharge.

Setting: Six Philadelphia academic and community hospitals.

Participants: Two hundred thirty-nine eligible patients were aged 65 and older and hospitalized with heart failure.

Intervention: A 3-month APN-directed discharge planning and home follow-up protocol.

Measurements: Time to first rehospitalization or death, number of rehospitalizations, quality of life, functional status, costs, and satisfaction with care.

Results: Mean age of patients (control n=121; intervention n=118) enrolled was 76; 43% were male, and 36% were African American. Time to first readmission or death was longer in intervention patients (log rank χ2=5.0, P=.026; Cox regression incidence density ratio=1.65, 95% confidence interval=1.13–2.40). At 52 weeks, intervention group patients had fewer readmissions (104 vs 162, P=.047) and lower mean total costs ($7,636 vs $12,481, P=.002). For intervention patients, only short-term improvements were demonstrated in overall quality of life (12 weeks, P<.05), physical dimension of quality of life (2 weeks, P<.01; 12 weeks, P<.05) and patient satisfaction (assessed at 2 and 6 weeks, P<.001).

Conclusion: A comprehensive transitional care intervention for elders hospitalized with heart failure increased the length of time between hospital discharge and readmission or death, reduced total number of rehospitalizations, and decreased healthcare costs, thus demonstrating great promise for improving clinical and economic outcomes.

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