Pilot Randomized Controlled Trial to Reduce Readmission for Heart Failure Using Novel Tablet and Nurse Practitioner Education - 16/08/18
, Scott Maffett, MD b, Randi E. Foraker, PhD c, Rod Sturdivant, PhD d, Kristina Moon, DO e, Ayesha Hasan, MD b, Veronica Franco, MD b, Sakima Smith, MD, MPH b, Brent C. Lampert, DO b, Sitaramesh Emani, MD b, Garrie Haas, MD b, Rami Kahwash, MD b, Ray E. Hershberger, MD b, Philip F. Binkley, MD, MPH b, Laura Helmkamp, MS f, Kathryn Colborn, PhD f, Pamela N. Peterson, MD, MSPH g, Nancy Sweitzer, MD, PhD a, William T. Abraham, MD bAbstract |
Background |
Heart failure education programs are not standardized. The best form of education is unclear. We evaluated whether addition of a novel tablet application to nurse practitioner (NP) education was superior to NP education alone in reducing 30-day readmission after heart failure hospitalization.
Methods |
From February 2015-March 2016, patients admitted to a quaternary academic center with primary diagnosis of heart failure were randomized to 1) treatment – NP education plus tablet application (interactive conditional logic program that flags patient questions to medical staff), or 2) control – NP education. The primary outcome was reduction in 30-day readmission rate. Secondary outcomes included satisfaction and education assessed via survey.
Results |
Randomization included 60 patients to treatment and 66 to control. A total of 13 patients withdrew prior to intervention (treatment n = 4, control n = 1) or were lost to follow-up (treatment n = 3, control n = 5). The 30-day readmission rate trended lower for treatment compared with control, but results were not statistically significant (13.2% [7/53], 26.7% [16/60], respectively, P = .08). Similarly, satisfaction trended higher with treatment than control (P = .08). Treatment patients rated explanations from their physicians higher than control (Always: 83.7%, 55.8%, respectively, P = .01).
Conclusions |
NP education plus tablet use was not associated with significantly lower 30-day readmission rates in comparison with NP alone, but a positive trend was seen. Patient satisfaction trended higher and heart failure explanations were better with NP education plus tablet. A larger study is needed to determine if NP education plus tablet reduces readmission rates following heart failure admission.
Le texte complet de cet article est disponible en PDF.Keywords : Educational technology, Heart failure, Nurse practitioner, Patient education, Readmission
Plan
| Funding: KB received support from the Ohio State University Department of Medicine seed grant award; National Institutes of Health (NIH) L60 MD010857; the University of Colorado, Department of Medicine, Health Services Research Development Grant Award; and the University of Arizona Health Sciences, Strategic Priorities Faculty Initiative Grant. EngineeredCare provided loaner tablets for this study. Tablet applications were developed by EngineeredCare and KB. |
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| Conflicts of Interest: KB has no ownership in EngineeredCare. No employees of EngineeredCare were included with analysis nor development of this manuscript. Otherwise there are no disclosures. |
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| Authorship: All authors had access to data and a role in writing this manuscript. |
Vol 131 - N° 8
P. 974-978 - août 2018 Retour au numéro
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