Document Type

Report

Publication Date

1-2018

Date of Final Presentation

Spring 3-8-2018

Committee Chair

Teresa Serratt PhD, RN

Committee Member

Pam Strohfus DNP, RN

Coordinator/ Chair of DNP Program

Pam Strohfus DNP, RN

Abstract/ Executive Summary

Background: Chronic congestive heart failure is the primary cause for hospitalizations among people 65 and over in the United States, resulting in two-thirds of all heart failure costs .Congestive heart failure (CHF) continues to be one of the most prevalent and expensive chronic illnesses to treat throughout the world in a time when cost-effectiveness, improved quality, and care based on outcomes is a requirement . Chronic heart failure is the primary cause for hospitalizations among people 65 and over in the United States, resulting in two-thirds of all heart failure costs (Lambrinou, Kalogirou, Lamnisos, & Sourtzi, 2012). Traditional approaches to disease management must be supplemented with affordable alternatives. Many factors leading to hospitalization and re-admission rates, such as non-adherence to treatment and failure to recognize signs and symptoms of decompensation are preventable (Lambrinou, et al., 2012). Research demonstrates that helping CHF patients acquire self-care management skills and behaviors promote clinical stability and reduce the amount of unscheduled acute care (Shively, et al., 2013). RN Care Managers at the Family Medicine at Richmond (FMR) clinic are highly experienced and possess the skills to facilitate improvement of CHF patient’s self-care management skills and behaviors; which are critical aspects of successful CHF managementResearch demonstrates that helping CHF patients acquire self-care management skills and behaviors promotes clinical stability and reduces the amount of unscheduled acute care (Shively, Gardetto, Kodiath, Kelly, Smith, Stepnowsky, Maynard, & Larson, 2013). . Current clinic structure fails to address these self-care management needs.

Project Design: A chronic disease nurse visit model was piloted at the Oregon Health and Science University (OHSU) Family Medicine at Richmond (FMR) Clinic , a a Federally Qualified Health Center (FQHC) Family Medicine Clinic. The quality improvement project focused on improvingto improve congestive heart failure patient self-care management skills and behaviors.. The Care Model (CM) was used as a guide for development of a chronic disease nurse visit using six major concepts: the health system, community support, self-management support, decision support, clinical information systems, and delivery system design. The nurse visit model focused on patient education of self-care management skills and behaviors using the CM as a framework. Improvement in self-care management of 15 patient participants was evaluated using the Care Model (CM) as a guide. Pusing physical assessment data, (daily weight, blood pressure, presence of edema, Paroxysmal Nocturnal Dyspnea (PND), and orthopnea), as well as medication and diet adherence, and a pre and post validated survey mean scores were used to measure change ining patient report of self-care management skills and behaviors. The Self Care of Heart Failure Index version 6.2 (SCHFIv6.2) is divided into three sections: maintenance, management, and confidence with a total of 23 questions answered using a Likert type scale .Additionally, unscheduled ER visits and CHF related hospitalizations will be assessed during the pilot to determine if patients experience a decrease in acute access for CHF symptoms.

Results: There was a 6% improvement overall in patient’s pre and post survey mean scores. Sixty percent (9 out of 15) of patients demonstrated a weight loss of one pound or more over the 90-day project, while 27% (4 out of 15) of patients experienced a 5% or more improvement in blood pressure and positive change in orthopnea. There were no significant changes in reported paroxysmal nocturnal dyspnea (PND), and at 90-day follow-up100% of patients reported the ability to recognize personal symptomology of worsening heart failure and what to do if experiencing symptom. Additionally, none of the patient participants experienced CHF related emergency room visits or hospitalizations.

Conclusion: Implementation of a chronic disease nurse visit model focused on patient education to facilitate development of better self-care management skills and behaviorsdemonstrated has the potential to improvement in the health of FMR CHF patient’s self-care management skills and behaviors by improving patient’s management of their chronic illness. Evidence found in the literature substantially supports this DNP project.

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