Patient-Centered Transition Care Model Fails to Improve Heart Failure Outcomes

A patient-centered care model designed to transition patients with heart failure (HF) from hospital-to-home failed to improve outcomes compared to a usual care program, according to research published in JAMA. 

Researchers for this study surmised that implementing a viable health care service that supports transition from hospital stay to home stands to improve outcomes in people with HF. Therefore, they sought to test the effectiveness of a patient-centered care transitions model on hospitalized HF patients. 

Gauging Model Effectiveness 

In this stepped-wedge cluster randomized trial of 2,494 patients (mean age, 77.7 years, 50.4% women) with HF across Ontario, between February 2015 and March 2016, researchers randomized 10 hospitals to implement the care model intervention (n= 1,104). The patient-centered program consisted of nurse-led self-care education, a structured hospital discharge summary, a family physician follow-up appointment within one week of discharge, as well as structured nurse home-visits and a heart function clinic for high-risk patients. In the usual care control group (n= 1,390), the transition plan was left to the discretion of physicians.  

The primary study outcomes were ranked ordered as a composite of all-cause readmission, emergency department (ED) visit, or death at three months; and a composite all-cause readmission or ED visit at 30 days. Secondary outcomes included a B-PREPARED score for rating discharge preparedness (range: 0 [most prepared] to 22 [least prepared]); the 3-Item Care Transitions Measure (CTM-3) for quality transition (range: 0 [worst transition] to 100 [best transition]); the 5-level (EQ-5D-5L) for quality of life (range: 0 [dead] to 1 [full health]; and quality-adjusted-life-years (QALY) (range: 0 [dead] to 0.5 [healthy at 6 months]). 

Care Model Fails to Move the Needle 

The results suggested that for all 2,494 eligible trial participants, there was no discernible differences between the patient-care and usual care groups for the first primary composite outcome events (545 [49.4%] vs. 698 [50.2%], respectively, (HR=0.99; 95% CI, 0.83 to 1.19]) nor in the second primary events (304 [27.5%] vs. 408 [29.3%], respectively, (HR=0.93, 95% CI, 0.73 to 1.18]). Although results did indicate perceptible differences at six weeks in the average scores between the two groups in secondary outcomes of B-PREPARED (16.6 vs. 13.9; difference, 2.65, 95% CI, 1.37 to 3.92], CTM-3 (76.5 vs. 70.3; difference, 6.16 [95% CI: 0.90 to 11.43]) and EQ-5D-5L score (0.7 vs. 0.6; difference, 0.06, 95% CI: 0.01 to 0.12), the trial rendered no significant difference in the QALY between the two groups at a six-month interval (0.3 vs. 0.3). 

The researchers concluded that in these HF patients, the patient-centered program having no effect on clinical outcomes compared to a usual care model. In a cessation of their findings, researchers remarked that whether “this type of intervention could be effective in other health care systems of locations would require further research.” 

SOURCEJAMA