Background: Congestive heart failure is a prevalent chronic condition among older Americans. Management of the condition often requires dramatic changes in patients’ lifestyles, including modifying diet, following an exercise plan, adhering to medication regimens, and self-monitoring. Most studies that have tested the effectiveness of tools to improve patient self-management and improve coordination of care have been hospital based.

Purpose: This study tested the effects of the Health Outcomes Management and Evaluation (HOME©) Plan, a quality improvement tool developed by the Visiting Nurse Service of New York (VNSNY), to determine its benefits for home care patients with congestive heart failure.

The tool consisted of standardized, clinically proven guidelines for nursing care and a patient self-care guide. The study hypothesized that use of the tool would allow nurses to deliver quality care in fewer visits, decrease variation in the number of visits they provided, and improve patients’ health outcomes and satisfaction with care.

Study Design: The study randomized 205 nurses caring for 371 VNSNY patients with congestive heart failure into an intervention or control group. Nurses in the intervention group provided care based on the HOME© Plan, and nurses in the control group provided usual care.

Summary Findings: The HOME© Plan reduced the number of skilled nursing visits to patients with congestive heart failure and the variation in the number of visits provided across patients without significantly increasing physician or emergency department (ED) use or patient mortality. The results also suggest that, among patients entering home care from a hospital setting, the HOME© Plan reduced the risk of ED use and lowered the likelihood of re-hospitalization. No differences in patient health outcomes or satisfaction with care were found between groups.

Conclusions: Evidence-based interventions can standardize home health nursing care and achieve meaningful reductions in service use, variability, and costs while having no deleterious effects on patients. Improving outcomes for patients with congestive heart failure, however, may require a more coordinated effort among the many providers throughout the health care system that deliver care to these patients.

Publications: article under review at The Gerontologist.

Sponsor: Health Services Quality Improvement Grants Program, New York State Department of Health.