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Heart failure (HF) is a costly chronic disease that affects 5.7 million people in the United States. Home healthcare agencies are implementing initiatives to reduce hospitalizations and manage HF patients at home. In this study, telemonitoring improved patients' perception of their quality of life and assisted them to sustain critical self-care behaviors. Patients who were monitored had fewer hospitalizations but telemonitoring was not statistically significant in lowering hospitalizations.

This article focuses on issues and research related to informal caregivers. The first 2 profiled studies looked at caregiver burden with 1 study conducted in the United States and the other in Thailand. Caregiver burden refers to the physical and emotional risks facing caregivers who are taking care of a relative or friend. Both found that the level of caregiver burden was related more to caregiver perception and attitude than to patient disease or other patient characteristic. Other important findings can be found in the summaries in this research brief. The third article profiles an investigation that was part of the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) initiative. Amanda Elliott and colleagues provide evidence of an intervention that was successful in improving caregiver health. The fourth write-up summarizes an important meta-analysis recently published on evaluating the effectiveness of family caregiver interventions on reducing behavioral and psychological symptoms in people with dementia and reducing caregiver negative reactions to these symptoms. Interested readers are encouraged to read the original articles for more details.

Heart failure (HF) is a progressive condition and is associated with high patient mortality rates and frequent hospitalizations. This article provides an overview of clinical, self-management support, and care transitions best practices for HF care in the home care sector. Clinicians armed with competencies in HF management are positioned to meet the 3-part aim of healthcare reform: improved health, better care, and lower cost.

This article details a heart failure care model at North East Veterans Affairs (VA) Medical Center. The North East VA health system has been involved in quality improvement of heart failure care for many years. This involves continuous quality improvement in the full spectrum of treatment from admission through discharge and outpatient follow-up. Improving patient care is always the main goal. Assisting patients to better understand self-care concepts is key to avoiding heart failure exacerbations. Educating patients to identify problematic symptoms early and access the system for help can often avoid costly readmissions. The case study provided in this article highlights the journey of a heart failure patient treated at this VA hospital and the care coordination process, which is necessary for good patient care through use of multidisciplinary team members.

The number of individuals diagnosed with heart failure continues to increase, often requiring repeated hospitalizations and readmissions. Patient education is essential for patients to self-manage this chronic illness. This study aims to describe nurses' knowledge of heart failure self-management education principles. Sixty-one nurses working in the community completed a 20-item survey, assessing their knowledge of diet, fluids, weight changes, signs and symptoms of worsening condition, medications, and exercise. Correct responses for individual survey items ranged from 14% to 100% with only 2 of 20 questions answered correctly by all participants. Frequently missed questions focused on notification of the physician regarding blood pressure, dizziness, weight monitoring, and use of salt substitutes. Findings of this study appear to suggest that an education and communication intervention may be effective at improving nurses' knowledge of heart failure education principles because more questions were answered correctly by >90% of nurses, following the intervention.

Home Health Compare rates for Emergent Care and Acute Hospitalization increased undesirably for Athens Regional Home Health. Data revealed that the increase was due to heart failure exacerbation. It was hypothesized that a chronic disease management program with telemonitoring, to include chest fluid bioimpedance, would allow for earlier intervention, thus preventing emergency department visits and acute care readmissions. This article describes the agency's performance improvement initiative that resulted in a decrease in these rates while improving patient outcomes and increasing agency referrals.

Theory-based teaching strategies for promoting adherence to a low-sodium diet among patients with heart failure are presented in this article. The strategies, which are based on the theory of planned behavior, address patient attitude, subjective norm, and perceived control as patients learn how to follow a low-sodium diet. Home health clinicians can select a variety of the instructional techniques presented to meet individual patient learning needs.

Hospitalization for heart failure accounts for a substantial portion of the overall cost of caring for these patients and is a predictor of shortened survival in patients with chronic HF. Avoidance of readmission is critical as those hospitalized with HF face a 50% rate of readmission within 6 months and 25%-35% incidence of mortality within a year.Knowledge of this syndrome is important in order to deliver comprehensive supportive care to these patients and reduce readmissions Intravenous drug therapy is an important adjunct in this effort. This article focuses on the syndrome as it relates to intravenous agents prescribed for the patient in the home setting.

Many changes have taken place in the field of home healthcare. Because of these changes, home health agencies must be creative and implement various tools that help improve quality of care for their patients. Starting with the most basic intervention definitely can lend a hand in improving patient outcomes. Phone monitoring, the most basic form of telehealth, can be an important aspect in a patient's plan of care.

Examining the benefits of nursing interventions through research significantly contributes to both professional nursing and quality healthcare, yet few benefits of home healthcare have been rigorously studied. Research challenges and lessons learned during a clinical trial of heart failure patients receiving home health nursing services are presented with recommendations.

This article examines the cultural influences of the Hispanic patient, such as health beliefs, communication styles, family and religious values, and time perception. In order to design and deliver individualized comprehensive care with the client and family, these assessment factors must be explored to create a plan of care that is tailored to meet the individualized needs of the patient and family. Understanding cultural influences that are important to the Hispanic cardiac client in the home care setting will have a positive impact on the nurse-patient relationship, the plan of care, and the management of the cardiac disease.

Frontloading, providing 60% of planned visits in the first 2 weeks of the home healthcare episode, was tested in two groups of patients: insulin-dependent patients with diabetes and patients with a primary diagnosis of heart failure. Frontloading was effective for patients with heart failure, decreasing rehospitalization by more than half (39.4-16%), with fewer visits (15.5 vs. 9.5) and equal clinical outcomes and patient satisfaction. There were no significant differences in outcomes for patients with diabetes.

This article reports a study that pilot tested the effectiveness of a low-technology structured intervention to standardize home healthcare management of patients with heart failure (HF) within a home health agency (HHA). The purpose of this study was to use low-technology equipment to improve care for patients with HF enrolled in a home health agency. The 9-week intervention was targeted toward the home health nurses and included telephone and home visits, a teaching tool, digital scales, and a log/notebook filled out by the patients in the study. Patient outcomes included decreased rehospitalization, decreased symptoms of HF, and increased quality of life.

This article describes the process used by one performance improvement committee to analyze comprehensive assessment data, including OASIS data, and relate it to nursing activities described in the clinical nursing notes. The end goal was to improve, or decrease, the hospital readmission rate of their patients with heart failure. The fit between patient characteristics and the plan of care described and delivered in two groups was evaluated. Differences in patient characteristics and nursing documentation of outcomes provided the data for remediation and for testing of a new intervention.

Congestive heart failure (CHF) is the leading cause of rehospitalization and loss of revenue for home care agencies and hospitals. This article outlines how an agency used telehealth to provide CHF patients quality care and improved outcomes while decreasing the number of skilled home nursing visits and reducing rehospitalization rates to 1.2%.

A home care agency's patient population with heart failure demonstrated improved outcomes after the agency implemented an evidence-based protocol. The model holds promise for use in other agencies working to improve patient outcomes as well as have an impact on decreasing costs.

Patients who experience severe symptoms of heart failure and repeated hospitalizations for exacerbations may benefit from positive inotropic drug infusion therapy such as dobutamine or milrinone. This article provides an overview of inotropic drug delivery in the home including current controversies and best practices to ensure safe home care policies and practice.

The literature addresses using multidisciplinary teams to manage outpatient heart failure patients to reduce hospital readmission rates, increase functional capacity, and improve quality of life. This article shows how a multidisciplinary team can be used for these same patients in a hospice home care program.

This study has shown improved outcomes with the use of a clinical pathway. However, under PPS additional ways for coordination among healthcare providers and patients need to be developed to ensure improved care beyond those focusing on the use of the pathway. One recommendation is the use of telehealth.

Although home care nursing has been associated with a lower rate of repeated hospitalization of persons with congestive heart failure, little is known about this relation. This study examined variables that reflect information about demographic characteristics, clinical status, nursing services, and repeated hospitalization for persons admitted with a primary diagnosis of congestive heart failure to one home care agency during one fiscal year. Implications related to assessment, documentation, patient instruction, and further research are discussed.

Heart failure is the number one hospital admission for the elderly and a leading client population for home care with numbers expected to rise steadily during the next decade. This article discusses systolic and diastolic heart failure, compensatory mechanisms, pathophysiology, and the signs and symptoms of right and left-sided heart failure. The most current treatment regimen for managing the heart failure patient in the home including medication, diet, activity, and patient education is presented.

This study compared elderly patients with congestive heart failure discharged from home healthcare to the home vs. those rehospitalized. The rate of rehospitalization in this sample of 117 was 27%. Significant predictors of rehospitalization included number of home healthcare days, number of previous hospitalizations, and the services of a home health aide. Implications include the timing and nature of home health visits.

Increasing self-efficacy is not a state that develops quickly. It is unrealistic to expect that the factors contributing to illness and disability will be modified easily. The home care nurse can positively influence self-efficacy expectations in the heart failure population by creating a supportive environment to perform physical activities (performance mastery), assisting with encouragement and support (verbal persuasion), providing anticipatory guidance and sharing how others perform (vicarious experience), and providing a realistic assessment of a person's abilities (physiologic state). By enhancing self-efficacy, the home care nurse can increase physical activity levels in this population, leading to decreased symptomatology and improved quality of life.

A case-management approach using clinical plans was developed to enhance outcomes. Patients with congestive heart failure (CHF) who were admitted to home care and case managed by nurses specially trained in cardiovascular nursing, case management, and the use of a clinical plan, had improved outcomes with fewer visits than patients with CHF managed with traditional care practices. Quality management and cost-effectiveness of patient care may be positively affected when using this approach.

Patients with congestive heart failure (CHF) constitute a substantial portion of the caseloads of home care agencies. Home care is one strategy suggested for delaying or preventing hospital readmissions. This study examined the relationship between home care nursing services and hospital readmissions after 1176 discharges of patients with a primary diagnosis of CHF. It also described the home nursing care of such patients. Findings indicate that patients receiving home care nursing services were readmitted to the hospital significantly less often within a period of 90 days after hospital discharge.

Hospital readmission for exacerbation of symptoms of Congestive Heart Failure (CHF) is a major home healthcare problem and expense. To address this problem and curb the increasing expense and patient lifestyle disruption, a group of staff nurses at the Medical University of South Carolina Medical Center developed a nurse-managed clinic to follow all patients with CHF after discharge. Within 6 months of the clinic's operation, readmissions of these patients decreased by 4%, and the length of stay decreased by 1.6 days.

A retrospective audit of the charts of 62 Medicare patients with diagnoses of congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) was conducted. Data that described marital status, number of visits made, number of hospital readmissions, and types of nursing interventions were collected. A significant relationship was found between certain nursing interventions and hospital readmissions.

Appropriate management of the patient with chronic congestive heart failure by the home health nurse is critical. Thorough assessment of the patient during the nursing visit can detect subtle changes in the patient's condition. Knowing what to look for and how to respond can improve the patient's quality of life significantly.