Study finds education reduces CHF readmissions
Few hospitals do it right
Improving patient understanding of congestive heart failure (CHF) helps promote better patient management of this chronic disease. Yet, many American hospitals fail to do an adequate job of educating CHF patients prior to hospital discharge, according to a quality improvement study conducted by IPRO, a health care quality evaluation organization in Lake Success, NY.
IPRO analyzed data from 686 inpatient records of Medicare patients hospitalized with CHF in 186 hospitals in New York state in 1993. Researchers looked for evidence that hospitals provided patient education during each admission for CHF. In particular, IPRO looked for documented patient education in the five categories recommended by the Agency for Health Care Policy and Research (AHCPR) in Silver Spring, MD. Those include:
• general counseling;
• activity recommendations;
• dietary recommendations;
• medication prescription;
• discharge planning.
"We found that general counseling was provided at maximum 26% of the time," notes Pascal James Imperato, MD, MPH &TM, medical director for research development and epidemiology for IPRO and distinguished professor and chairman of the department of preventive medicine and community health at the State University of New York in New York City. AHCPR defines general counseling as a discussion of CHF and its symptoms and causes as well as the use of daily weight monitoring, he adds.
Other relevant study findings include:
• Recommendations regarding general activities to avoid were provided in 87% of cases.
"The problem is that most patients were never told what they could do," says Imperato. "One wants CHF patients to be mobile, ambulatory, [and to] tone up muscles. Unfortunately, most CHF patients leave the hospital with the impression that they are invalids. In fact, only 20% of patients in our study were told what they could do, and even fewer were referred into cardiac rehab programs," he adds.
• Dietary consultations took place 74% of the time, and a discharge diet was provided to 90% of cases.
"Most hospitals did go over dietary guidelines with their CHF patients," says Imperato. "However, only 14% of patients actually got a written copy of their diet to take home with them."
"If you have a sick patient in the hospital being impacted with a great deal of information, much of the information becomes incomprehensible," he warns. (For further discussion of the need for ongoing education for CHF patients, see story on p. 46.)
"In addition, we found that only 9% of all patients in the study were cautioned about avoiding excess fluids as part of their dietary consultation," Imperato says.
• Medication education including drug names and dosages occurred in 96% of cases.
"Almost all patients were told about their medications, but only 10% were told about possible side effects, 3% the consequences of missing a dose, and 18% the purpose of the drug," notes Imperato.
• A discharge plan was provided in more than 80% of cases.
IPRO is currently implementing a pilot program in 15 hospitals in the Buffalo, NY, region. "We’re trying to develop a uniform discharge management plan for treating and educating Medicare inpatients with CHF that comply with the AHCPR guidelines," notes Imperato. "We’re looking at the best ways and times to communicate the necessary information to patients who are very anxious and sick."
IPRO has developed educational and instructional tools for use in the pilot program.
[For further information on the pilot and the CHF resources, contact: IPRO, 1979 Marcus Ave., Lake Success, NY 11042-1002. Telephone: (516) 326-7767. Fax: (516) 328-2310.]
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