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Heart failure is a global epidemic with debilitating effects. People with heart failure need to actively participate in home self-care regimens to maintain good health. However, these regimens are not as effective as they could be and are influenced by a variety of factors. Patients from minority communities like African American (AA) and Hispanic/Latino (H/L), often have poor outcomes compared to the average Caucasian population. In this paper, we lay the groundwork to develop an interactive dialogue agent that can assist AA and H/L patients in a culturally sensitive and linguistically accurate manner with their heart health care needs. This will be achieved by extracting relevant educational concepts from the interactions between health educators and patients. Thus far we have recorded and transcribed 20 such interactions. In this paper, we describe our data collection process, thematic and initiative analysis of the interactions, and outline our future steps.

Most of the health documents, including patient education materials and discharge notes, are usually flooded with medical jargons and contain a lot of generic information about the health issue. In addition, patients are only provided with the doctor’s perspective of what happened to them in the hospital while the care procedure performed by nurses during their entire hospital stay is nowhere included. The main focus of this research is to generate personalized hospital-stay summaries for patients by combining information from physician discharge notes and nursing plan of care. It uses a metric to identify medical concepts that are Complex, extracts definitions for the concept from three external knowledge sources, and provides the simplest definition to the patient. It also takes various features of the patient into account, like their concerns and strengths, ability to understand basic health information, level of engagement in taking care of their health, and familiarity with the health issue and personalizes the content of the summaries accordingly. Our evaluation showed that the summaries contain 80% of the medical concepts that are considered as being important by both doctor and nurses. Three patient advisors (i.e. individuals who are trained in understanding patient experience extensively) verified the usability of our summaries and mentioned that they would like to get such summaries when they are discharged from hospital.

Introduction Patients with low socioeconomic status (SES) have worse heart failure (HF) outcomes than patients with high SES, including higher readmissions. Interventions to improve outcomes in low SES patient populations have not been successful however the reasons remain unclear. Objective To describe the social factors impacting psychological stress and self-care in a low SES patient population with HF and multiple readmissions. Methods In this mixed methods study, 35 subjects with low SES participated in semi-structured interviews about personal and community factors impacting their stress and self-care. Subjects were interviewed during an inpatient readmission for acute decompensated heart failure from two urban hospitals in Chicago. Subjects completed standardized instruments measuring psychological stress (PSS-10), and self-care (SCHFI). Subjects were categorized into high stress (PSS-10 >20) and moderate/low stress (PSS-10 Results Ninety one percent of subjects were African American and 91% were from neighborhoods with high rates of poverty and violence according to US Census data. Subjects experienced a range of admissions (2–12) within the previous 180 days of the current HF admission. Across all three SCHFI sub-scales, the majority of scores were 20 (PSS-10 (14.9 [8.2]). The overarching qualitative theme was that social factors and psychological stress influence self-care. Subjects described the following events as stressful and impacting their self-care: financial difficulties, concern for children/grandchildren's safety, personal health, past impactful deaths, and a recent stressful event. Among subjects whose PSS-10 scores were Conclusion Social factors and psychological stress has impacted the ability of this low SES patient population to perform adequate HF self-care. Research to develop and test sensitive interventions that address social determinants influencing self-care are needed since low SES patient populations continue to experience poorer outcomes.

Background The Northwestern University Center for Education and Research on Therapeutics (CERT), funded by the Agency for Healthcare Research and Quality, is one of seven such centers in the USA. The thematic focus of the Northwestern CERT is ‘Tools for Optimizing Medication Safety.’ Ensuring drug safety is essential, as many adults struggle to take medications, with estimates indicating that only half of adults take drugs as prescribed. This report describes the methods and rationale for one innovative project within the CERT: the ‘Primary Care, Electronic Health Record-Based Strategy to Promote Safe and Appropriate Drug Use’. Methods/Design The overall objective of this 5-year study is to evaluate a health literacy-informed, electronic health record-based strategy for promoting safe and effective prescription medication use in a primary care setting. A total of 600 English and Spanish-speaking patients with diabetes will be consecutively recruited to participate in the study. Patients will be randomized to receive either usual care or the intervention; those in the intervention arm will receive a set of print materials designed to support medication use and prompt provider counseling and medication reconciliation. Participants will be interviewed in person after their index clinic visit and again one month later. Process outcomes related to intervention delivery will be recorded. A medical chart review will be performed at 6 months. Patient outcome measures include medication understanding, adherence and clinical measures (hemoglobin A1c, blood pressure, and cholesterol; exploratory outcomes only). Discussion Through this study, we will be able to examine the impact of a health literacy-informed, electronic health record-based strategy on medication understanding and adherence among diabetic primary care patients. The measurement of process outcomes will help inform how the strategy might ultimately be refined and disseminated to other sites. Strategies such as these are needed to address the multifaceted challenges related to medication self-management among patients with chronic conditions. Trial registration Clinicaltrials.gov NCT01669473.

To the Editor: In 2009, the Centers for Medicare and Medicaid Services began reporting publicly 30-day readmission rates for acute decompensated heart failure in an effort to highlight preventable readmissions, improve care, and control costs. This decision was based, in part, on recent observations of elderly Medicare fee-for-service beneficiaries that found a median readmission rate of 24.4% (range, 15.9% to 34.4%).1 A follow-up study by Ross et al2 published in Circulation: Heart Failure evaluated trends in readmission after acute decompensated heart failure hospitalization and found similar readmission rates (23.7% to 23.9%) over the 3-year period from 2004 to 2006. Both of these …

Patients with chronic conditions like heart failure are the most likely to be re-hospitalized. One step towards avoiding re-hospitalization is to devise strategies for motivating patients to take care of their own health. In this paper, we perform a quantitative analysis of patients’ narratives of their experience with heart failure and explore the different topics that patients talk about. We compare two different groups of patients- those unable to take charge of their illness, and those who make efforts to improve their health. We will use the findings from our analysis to refine and personalize the summaries of hospitalizations that our system automatically generates.

Background The goal of this study was to determine if left ventricular (LV) global longitudinal strain (GLS) predicts heart failure (HF) readmission in patients with acute decompensated heart failure. Methods and results Two hundred ninety one patients were enrolled at the time of admission for acute decompensated heart failure between January 2011 and September 2013. Left ventricle global longitudinal strain (LV GLS) by velocity vector imaging averaged from 2, 3 and 4-chamber views could be assessed in 204 out of 291 (70%) patients. Mean age was 63.8 ± 15.2 years, 42% of the patients were males and 78% were African American or Hispanic. Patients were followed until the first HF hospital readmission up to 44 months. Patients were grouped into quartiles on the basis of LV GLS. Kaplan-Meier curves showed significantly higher readmission rates in patients with worse LV GLS (log-rank p

Background Measurement of myocardial perfusion reserve (MPR) can potentially extend the scope of conventional myocardial perfusion imaging from detection of flow limiting epicardial stenosis to assessment of coronary microvascular function. Recent studies have suggested that MPR may improve risk stratification of patients with known or suspected CAD. MPR has traditionally been measured using PET or CMR time-intensity curves. However, these techniques are cumbersome, require radiation (for PET) and are not practical for routine clinical practice. Measurement of coronary sinus (CS) flow with phase-contrast MRI is an alternative, simple method for assessing MPR. The aim of this study was to identify the clinical determinants of MPR using this method in patients with symptoms of possible myocardial ischemia presenting for CMR stress testing.