Heart failure is a cardiac condition that causes a substantial burden on both health systems and patients because of preventable hospital admissions. Patients with heart failure are frequently hospitalized to help control some of the most common symptoms including shortness of breath, fatigue, and swelling of the feet. One week after getting discharged from the hospital, 40 percent of heart failure patients still report burdensome symptoms, and 25 percent of patients will return to the hospital within 30 days of being discharged. Though studies suggest that patients should follow up with their healthcare providers soon after discharge, low appointment availability, transportation to clinics, and limited ability of patients and caregivers to administer needed medical therapies have prevented many patients from receiving proactive management that can improve patient outcomes. The purpose of this study is to reduce hospital readmissions and symptom burden and improve the quality of care that heart failure patients receive after discharge from the hospital.
In this project, we will compare a Mobile Integrated Health (MIH) intervention to a transitions of care coordinator (TCC). MIH leverages paramedics in the community and telemedicine (technology-enabled communication for health purposes) to provide medical care to heart failure patients in the home. The TCC group will receive a follow-up phone call shortly after discharge in which the patient is assessed and connected to clinical and social services as needed and patient education is reinforced. Patients will be randomly assigned to receive either MIH or TCC.
The specific aims for this project are to compare the effectiveness of MIH to TCC on preventable healthcare utilization (e.g., hospitalizations at 30 days, emergency room visits) (Aim 1); healthcare quality (e.g., days at home, prescribed specific medications) (Aim 2); and patient-reported outcomes (e.g., quality of life, symptoms) (Aim 3). We will also evaluate factors that support adoption, implementation, and maintenance from the perspective of multiple key stakeholders (Aim 4). The study population will include a diverse mix of patients who meet the following inclusion criteria for the study: have a diagnosis of heart failure, speak English or Spanish, are 65 years and older, and primarily receive their health care at the NewYork-Presbyterian or Mount Sinai health systems. These patients will be recruited and enrolled during their hospitalization, prior to discharge to home.
The primary outcome in this study is any 30-day hospital readmissions. Secondary outcomes include preventable emergency department visits, preventable hospital admissions from the emergency department, number of days spent at home (versus in a hospital or emergency department), quality of heart failure care, and changes in symptoms and quality of life for 30 days after hospital discharge. In designing, implementing, and evaluating this project, we have and will continue to engage key stakeholders to understand factors that are important for MIH to be adopted, implemented, and maintained in real-world settings. Examples of stakeholders include patients, caregivers, and healthcare providers involved in MIH, such as nurse care coordinators, community paramedics, and physicians. We have used patient engagement platforms through the New York City-based INSIGHT Clinical Research Network to convene a team of stakeholders with specific expertise in the management, treatment, and lived experiences of heart failure. We anticipate that these study findings will provide rigorous evidence about the potential for MIH to improve health outcomes for patients with heart failure by reducing hospitalizations, improving care, and improving symptoms and health status as experienced by patients. The study findings will also be available to patients and caregivers who may be able to opt for MIH follow-up after a hospitalization for heart failure, healthcare administrators, and healthcare providers who are looking for better ways to support transitions of care from the hospital to the home.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.