Across the US, 22% of Medicare patients hospitalized with a diagnosis of heart failure (HF) will be readmitted within 30-days of discharge. There is no one costeffective process identified to help patients transition home and maintain their own selfcare. The aim of this study is to compare readmission rates, HF knowledge, self-care, and quality of life for patients who transition home from the hospital under the care of a Heart Failure Nurse Navigator (HFNN) with patients who receive usual care. The HFNN is a home health RN with specialized training in HF care. The HFNN visited intervention group (IG) participants once in the hospital, followed by weekly home visits for one month. Control group (CG) participants received usual care, consisting of discharge teaching by their primary nurse and follow-up with their primary care provider (PCP) or cardiologist. Using a sequential mixed methods research design, this experimental randomized controlled trial measured HF knowledge, HF self-care, and HF quality of life (QOL) at enrollment and one month after discharge. Hospital readmissions and/or ED visits were tracked in both groups. IG participants were interviewed using semi-structured questions, findings of which were analyzed using conventional content analysis. There were fewer all-cause hospital readmissions in the IG (3 of 19) than the CG (6 of 21.) CG participants were 2.2 times more likely to be readmitted than the IG participants. [x(1)=.935, p=.334 O.R.=2.2219]. Due to limited enrollment, these results were underpowered and not statistically significant. There was improvement in HF knowledge (p=.06) and HF self-care maintenance (p=.07), approaching significance. HF self-care maintenance improved in both groups, although the IG was not significantly better (p=.48). There was significant improvement in the IG for HF confidence (p=.002) and HF QOL (p<.001). The qualitative findings revealed two main categories from the IG: (1) personal clarification of patient education, especially related to diet, exercise, and medications and (2) feelings of support, reassurance, and safety. The HFNN may be one role to meet the triple aim of improving patient quality care and health outcomes at a reduced cost, especially in areas where a comprehensive HF management program is not available. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Com o objetivo de avaliar o atendimento dos pacientes submetidos à intervenção cirúrgica cardiovascular no protocolo de atendimento na via rápida (fast track recovery) em relação ao protocolo convencional, foi comparada a movimentação dos pacientes atendidos em ambos os protocolos nas diferentes unidades hospitalares. O estudo foi realizado em hospital público universitário especializado em cardiologia de 400 leitos, de referência terciária para o Sistema Único de Saúde. Foram estudados 175 pacientes, 107 (61%) homens e 68 (39%) mulheres, de idades entre 2 meses a 81 anos, dos quais 107 operados no protocolo da via rápida e 68 no protocolo convencional. Foram avaliadas variáveis demográficas, clínicas e, para avaliar a movimentação dos pacientes nas diferentes unidades hospitalares, as taxas de alta por unidade de tempo em cada unidade. A análise estatística foi feita por meio de análise exploratória, método de Kaplan Meier e modelo de riscos proporcionais de Cox. A análise de variância foi empregada para comparar o faturamento das despesas. A taxa de alta das diferentes unidades hospitalares por unidade de tempo dos portadores de cardiopatia congênita atendidos no protocolo da via rápida em relação ao protocolo da via convencional foi: a) 11,3 vezes a taxa de alta quando assistidos no protocolo na via convencional quanto ao tempo de permanência no centro cirúrgico; b) 6,3 vezes quanto à duração da intervenção cirúrgica; c) 6,8 vezes quanto à duração da anestesia; d) 1,5 vezes quanto à duração da perfusão; e) 2,8 vezes quanto à permanência na unidade de recuperação pós-operatória I; f) 6,7 vezes quanto à duração da hospitalização; g) 2,8 vezes quanto à permanência na unidade de internação pré-operatória; h) 2,1 vezes quanto à permanência na unidade de internação após a alta da unidade de terapia intensiva de recuperação pós-operatória. Para os portadores de cardiopatia isquêmica, as taxas de alta das unidades hospitalares para os protocolos de atendimento no protocolo da via rápida e no protocolo convencional não demonstraram diferença estatisticamente significante. Os valores de faturamento das despesas de internação dos portadores de cardiopatia congênita decorrentes de exames e procedimentos realizados nas fases pré- e pós-operatória e dos exames da fase trans-operatória foram menores quando os pacientes foram assistidos no protocolo da via rápida. Portanto, os portadores de cardiopatias congênita apresentaram menor permanência hospitalar nos recursos médicos hospitalares instalados, quando assistidos no protocolo de atendimento na via rápida, bem como menores despesas nas fases pré- e pós- operatória da internação. / Objective - To evaluate patient assistance in pre, per and postoperative phases of cardiac surgical intervention under fast track recovering protocol compared to the conventional way. Patients - 175 patients were studied, 107 (61%) men and 68 (39%) women. Ages 2 months to 81 years old. Patients included: first surgical intervention, congenital and ischemic cardiopathy without complexity, normal ventricular function and with at least 2 preoperative ambulatory consultations. Patients submitted to emergency surgeries were excluded. Interventions - assistance submitted by fast track and conventional protocol. Statistical analysis (measures) - exploratory, uni-varied (Kaplan Meier) and multi-varied (Cox) of the time in each admission unit. Hospital installations were classified in ambulatory, preoperative admission unit, surgical center, postoperative recovery unit and postoperative admission unit; the expression of this use was the discharge rate by unit of time from the significant interaction observed between assistance protocol and the kind of cardiopathy for the stay in the surgical center, surgical intervention time, stay in postoperative recovery unit, anesthesia time and time between admission and surgery dates. Results - the patients of congenital cardiopathy who underwent the protocol of conventional way recovery in relation to the fast track protocol, in the reliability range of 95% allows one to state that discharge rate by unit of time of the congenital cardiopathy patients assisted by the fast track protocol was: 11.3 times the discharge rate when assisted by the conventional way protocol as to the time of staying in the surgical center; 6.3 times as to the duration of the surgical intervention; 6.8 times as to duration of the anesthesia; 1.5 times as to the duration of the perfusion; 2.8 times as to the stay in the postoperative recovery unit; 6.7 times as to the stay in the hospital (period of time between the admission and the discharge date); 2.8 times as to the stay in the preoperative admission unit ( period of time between the admission date and the surgery date); 2.1 times as to the stay in the postoperative unit (period of time between the date of leaving the postoperative recovery unit and the date of discharge from the hospital). For the ischemia cardiopathy patients the risks concerning the protocols of recovery by the traditional way and the fast track were the same. CONCLUSIONS - The data concerning this study allows one to suggest that the assistance can be more efficient if one takes into consideration some variables studied in the protocol of fast track recovery. The congenital and ischemic cardiopathy patients presented shorter interval of time (concerning hospital stay in doctor-hospital installed facilities) when assisted in the fast track recovery protocol as well as fewer expenses with medical and hospital assistance.

Com o objetivo de avaliar o atendimento dos pacientes submetidos à intervenção cirúrgica cardiovascular no protocolo de atendimento na via rápida (fast track recovery) em relação ao protocolo convencional, foi comparada a movimentação dos pacientes atendidos em ambos os protocolos nas diferentes unidades hospitalares. O estudo foi realizado em hospital público universitário especializado em cardiologia de 400 leitos, de referência terciária para o Sistema Único de Saúde. Foram estudados 175 pacientes, 107 (61%) homens e 68 (39%) mulheres, de idades entre 2 meses a 81 anos, dos quais 107 operados no protocolo da via rápida e 68 no protocolo convencional. Foram avaliadas variáveis demográficas, clínicas e, para avaliar a movimentação dos pacientes nas diferentes unidades hospitalares, as taxas de alta por unidade de tempo em cada unidade. A análise estatística foi feita por meio de análise exploratória, método de Kaplan Meier e modelo de riscos proporcionais de Cox. A análise de variância foi empregada para comparar o faturamento das despesas. A taxa de alta das diferentes unidades hospitalares por unidade de tempo dos portadores de cardiopatia congênita atendidos no protocolo da via rápida em relação ao protocolo da via convencional foi: a) 11,3 vezes a taxa de alta quando assistidos no protocolo na via convencional quanto ao tempo de permanência no centro cirúrgico; b) 6,3 vezes quanto à duração da intervenção cirúrgica; c) 6,8 vezes quanto à duração da anestesia; d) 1,5 vezes quanto à duração da perfusão; e) 2,8 vezes quanto à permanência na unidade de recuperação pós-operatória I; f) 6,7 vezes quanto à duração da hospitalização; g) 2,8 vezes quanto à permanência na unidade de internação pré-operatória; h) 2,1 vezes quanto à permanência na unidade de internação após a alta da unidade de terapia intensiva de recuperação pós-operatória. Para os portadores de cardiopatia isquêmica, as taxas de alta das unidades hospitalares para os protocolos de atendimento no protocolo da via rápida e no protocolo convencional não demonstraram diferença estatisticamente significante. Os valores de faturamento das despesas de internação dos portadores de cardiopatia congênita decorrentes de exames e procedimentos realizados nas fases pré- e pós-operatória e dos exames da fase trans-operatória foram menores quando os pacientes foram assistidos no protocolo da via rápida. Portanto, os portadores de cardiopatias congênita apresentaram menor permanência hospitalar nos recursos médicos hospitalares instalados, quando assistidos no protocolo de atendimento na via rápida, bem como menores despesas nas fases pré- e pós- operatória da internação. / Objective - To evaluate patient assistance in pre, per and postoperative phases of cardiac surgical intervention under fast track recovering protocol compared to the conventional way. Patients - 175 patients were studied, 107 (61%) men and 68 (39%) women. Ages 2 months to 81 years old. Patients included: first surgical intervention, congenital and ischemic cardiopathy without complexity, normal ventricular function and with at least 2 preoperative ambulatory consultations. Patients submitted to emergency surgeries were excluded. Interventions - assistance submitted by fast track and conventional protocol. Statistical analysis (measures) - exploratory, uni-varied (Kaplan Meier) and multi-varied (Cox) of the time in each admission unit. Hospital installations were classified in ambulatory, preoperative admission unit, surgical center, postoperative recovery unit and postoperative admission unit; the expression of this use was the discharge rate by unit of time from the significant interaction observed between assistance protocol and the kind of cardiopathy for the stay in the surgical center, surgical intervention time, stay in postoperative recovery unit, anesthesia time and time between admission and surgery dates. Results - the patients of congenital cardiopathy who underwent the protocol of conventional way recovery in relation to the fast track protocol, in the reliability range of 95% allows one to state that discharge rate by unit of time of the congenital cardiopathy patients assisted by the fast track protocol was: 11.3 times the discharge rate when assisted by the conventional way protocol as to the time of staying in the surgical center; 6.3 times as to the duration of the surgical intervention; 6.8 times as to duration of the anesthesia; 1.5 times as to the duration of the perfusion; 2.8 times as to the stay in the postoperative recovery unit; 6.7 times as to the stay in the hospital (period of time between the admission and the discharge date); 2.8 times as to the stay in the preoperative admission unit ( period of time between the admission date and the surgery date); 2.1 times as to the stay in the postoperative unit (period of time between the date of leaving the postoperative recovery unit and the date of discharge from the hospital). For the ischemia cardiopathy patients the risks concerning the protocols of recovery by the traditional way and the fast track were the same. CONCLUSIONS - The data concerning this study allows one to suggest that the assistance can be more efficient if one takes into consideration some variables studied in the protocol of fast track recovery. The congenital and ischemic cardiopathy patients presented shorter interval of time (concerning hospital stay in doctor-hospital installed facilities) when assisted in the fast track recovery protocol as well as fewer expenses with medical and hospital assistance.