Improvement of Heart Failure-Related Self Care Levels with Telehealth Use

Purpose: Heart failure management with telehealth use in the outpatient setting is associated with decreased hospital readmissions, increased health-related quality of life, and improved self-care levels. However, prior to COVID-19, the use of telehealth interventions for outpatient management was uncommon. The pandemic transformed the outpatient management approach of chronic disease patients within the United States, leading to a rapid increase in outpatient telehealth use. The evidence-based quality improvement project aimed to determine if telephone-based personalized education sessions improved heart failure-related self-care levels and rehospitalization rates over twelve months in four adult patients. The intended improvement of the evidence-based quality improvement project was to assist heart failure patients in self-care management, maintenance, and confidence behaviors and assess how to improve compliance levels with telehealth methods in the outpatient setting.
Description: The project intervention opted to utilize telehealth visits via telephone calls to conduct personalized education sessions. A quantitative, quasi-experimental, one-group, pre-/post-test design was used. The project intervention included two to four telephone-based education sessions personalized for each participant based on their pre-intervention self-care of heart failure index scores. The self-care of heart failure index was mailed to each participant via the United States Postal Service and returned to the project team leader for analysis prior to the first education session. Personalized education plans were then created according to each participant’s self-care of heart failure index responses. Each session was allotted thirty minutes in duration and was followed up with an email to the participant, including additional educational information and website links if necessary. After each session, the information and feedback were used to plan each subsequent session for up to four sessions, depending on the needs of each participant. Twelve months after the education sessions were complete, the self-care of heart failure index was readministered to the participants and compared to their pre-intervention results to determine the effect that personalized education sessions had on their heart failure-related self-care levels. The number of self-reported hospitalizations during the twelve-month post-intervention period were compared to the number of self-reported hospitalizations in the twelve-month pre-intervention period to determine if the personalized education sessions affected the number of heart failure-related hospitalizations.
Evaluation/outcome: The primary outcomes of the quality improvement project were the improvement of heart failure-related self-care levels and the reduction of heart failure-related rehospitalization rates. If the primary outcomes were achieved, the use of telehealth-based patient education sessions and management of heart failure in the outpatient setting could provide strongly supported evidence for widespread implementation. Improved treatment adherence was the anticipated secondary outcome. The project data collection is completed at this time and is currently awaiting statistical analysis. Ideally, the evidence-based quality improvement project would have included more participants and had education sessions conducted with video calls along with the telephone sessions. Preliminary results have shown a positive response from participants regarding the telephone-based personalized education sessions and could indicate a promising and evolving future for telehealth-based personalized education for heart failure patients in the outpatient setting.