Back to Search
Start Over
Effect of Nurse-Implemented Transitional Care for Chinese Individuals with Chronic Heart Failure in Hong Kong: A Randomized Controlled Trial.
- Source :
- Journal of the American Geriatrics Society; Aug2015, Vol. 63 Issue 8, p1583-1593, 11p, 1 Diagram, 3 Charts, 1 Graph
- Publication Year :
- 2015
-
Abstract
- Objectives To determine the effect of nurse-implemented transitional care ( TC) on readmission and mortality rates in Chinese individuals with chronic heart failure ( CHF) in Hong Kong. Design Single-center randomized controlled trial of TC versus usual care ( UC). Setting University-affiliated hospital in Hong Kong. Participants Hospitalized Chinese individuals with CHF (N = 178; aged 78.6 ± 6.9, 45% male). Measurements: The TC group received a predischarge visit, two home visits, and then regular telephone calls over 9 months to provide self-care education and support, optimized health surveillance, and facilitation in use of community services. Primary endpoints were event-free survival, all-cause hospital readmission, and mortality during the 9-month follow-up. Secondary endpoints were length of hospital stay, self-care, and health-related quality of life ( HRQL). Data were analyzed using survival analysis and generalized estimating equations, following an intention-to-treat principle. Results Survival analysis indicated no significant differences in event-free survival, hospital readmission, or mortality between the TC and UC groups, although the TC group had a lower hospital readmission rate at 6 weeks (8.1% vs 16.3%, P = .048) and lower mortality at 9 months (4.1% vs 13.8%, P = .03). The TC group also had a shorter hospital stay ( P = .006) and significantly better self-care and HRQL. Because of attrition, sensitivity analyses were conducted to examine whether the intention-to-treat assumption affected the results. Per-protocol population analyses (hazard ratio ( HR) = 0.40, 95% confidence interval ( CI) = 0.17-0.93) and worst-case-scenario analysis ( HR = 0.44, 95% CI = 0.25-0.77) suggested a lower mortality risk in the TC group. Conclusion The translation of individual-centered nurse-implemented TC to the Chinese culture and healthcare context of Hong Kong appears beneficial. [ABSTRACT FROM AUTHOR]
- Subjects :
- ACADEMIC medical centers
CHI-squared test
CONFIDENCE intervals
STATISTICAL correlation
HEART failure
LENGTH of stay in hospitals
PATIENT aftercare
EVALUATION of medical care
MORTALITY
NURSES
QUALITY of life
STATISTICAL sampling
HEALTH self-care
SURVIVAL analysis (Biometry)
SURVIVAL
T-test (Statistics)
DISEASE management
OCCUPATIONAL roles
RANDOMIZED controlled trials
PATIENT readmissions
DATA analysis software
DESCRIPTIVE statistics
KAPLAN-Meier estimator
Subjects
Details
- Language :
- English
- ISSN :
- 00028614
- Volume :
- 63
- Issue :
- 8
- Database :
- Complementary Index
- Journal :
- Journal of the American Geriatrics Society
- Publication Type :
- Academic Journal
- Accession number :
- 108997320
- Full Text :
- https://doi.org/10.1111/jgs.13533