Effectiveness of Telenursing in Managing the Heart Failure Patient Population

Purpose:  The purpose of this study is to test the effectiveness of TeleNursing in assisting individuals with heart failure to effectively self-manage their care; and by so doing, improve quality of life, health status, and decrease hospital readmissions.

Population/Sample Studied: The population studied was patients with the diagnosis of heart failure (DRG 127) at Tripler Army Medical Center and The Queen’s Medical Center, Honolulu, Hawaii, who meet the inclusion criteria during the data collection period.   

Data Collection Method(s): A pre-test/post-test control group design was used. The intervention of TeleNursing was compared to the telephone intervention.  The dependent variables were: readmission rates, self-care ability as measured by the Exercise of Self-Care Agency Questionnaire, health status as measured by the Standard Form SF-36 Health Survey, and quality of life as measured by the Minnesota Living with Heart Failure Questionnaire.  The population studied was patients with the diagnosis of heart failure (DRG 127) at Tripler Army Medical Center and The Queen’s Medical Center, Honolulu Hawaii, who meet the inclusion criteria during the data collection period.  Subjects who meet the inclusion criteria were  randomized into one of two study arms: 1) TeleNursing or 2) Telephone intervention.  

Data Analysis Method(s): T-tests and Fisher’s Exact tests were used to compare demographic data, clinical characteristics and initial survey scores between participants who completed the study vs. those who did not, between participants recruited from the clinic vs. those recruited from the hospital and between participants from the military medical center vs. the civilian medical center. These tests revealed that there were no statistically significant differences among any of these groups.  Based on these results, the decision was made to combine military and civilian subjects for the analyses.  Four post-test variables (LHFQ, SF-36 MCS, SF-36 PCS, and ESCA) were separately analyzed to determine the impact of the interventions using an analysis-of-covariance design with the appropriate pre-test score and the Charlson Co-Morbidity Index as covariates in each analysis.  The analysis-of-covariance design was used to statistically control for initial differences in the subjects that might have been present.  Paired T-Tests and Wilcoxen Signed Rank tests were also used to analyze the difference between pre- and post- test scores for each intervention separately.  This was done to determine whether each intervention had an impact on the four variables.

Findings:  The initial sample consisted of 36 men and 22 women (n = 58 subjects).  Thirteen of the 58 did not complete the study: 6 died during the study period, 1 was transferred to a hospice, 1 never experienced the intervention due to an inability to install teleconferencing equipment and 1 withdrew before any data were obtained.  The remaining four withdrew for a variety of personal reasons unrelated to the study.  Demographic and clinical differences between military and civilian subjects or between subjects by intervention or inpatient/outpatient site were not significant.  Similarly, there were no significant differences on any demographic or clinical characteristics between those who did not complete the study and those who did.  Overall, the sample that completed the study was older (mean + SD age, 65 + 14 years, predominantly male (62%), lived with a spouse or significant other (79%) and retired (57%).  Slightly more than half the sample was Caucasian (51%) with the remainder divided among Asian (26%), Pacific Islander (13%), Black, Hispanic, Native American and other were each 2%.

Nursing Implications:  Considered a major health problem, accounting for more than 5 million hospital days at a cost of $10 billion dollars annually.  The potential effect on the Military causes an urgent need to improve the management of the U.S. healthcare budget.  More importantly,

this study demonstrated that follow up care for patients with congestive heart failure can be provided either by a TeleNursing or Telephone Intervention.  The modality of delivery to a patient with congestive heart failure is not as important as the patient education material provided to the patient.

Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2013104...