Nurse-led multidisciplinary heart failure group clinic appointments: Methods, materials, and outcomes used in the clinical trial

Journal of Cardiovascular Nursing

Volumn 30, Issue 4, 2015, Pages S25-S34

  Smith, Carol E ^a   Piamjariyakul, Ubolrat ^a   Dalton, Kathleen M ^b   Russell, Christy ^b   Wick, Jo ^c   Ellerbeck, Edward F ^c  

^a UNIVERSITY OF KANSAS SCHOOL OF NURSING   (United States)

^b UNIVERSITY OF KANSAS   (United States)

^c UNIVERSITY OF KANSAS   (United States)

Author keywords

Group clinic appointments; Heart failure; Rehospitalizations

Indexed keywords

CARDIOVASCULAR NURSING; CONTROLLED STUDY; FEMALE; GROUP PROCESS; HEART FAILURE; HOSPITAL MANAGEMENT; HOSPITAL READMISSION; HUMAN; MALE; MIDDLE AGED; OUTPATIENT DEPARTMENT; PATIENT CARE; RANDOMIZED CONTROLLED TRIAL; SELF CARE;

AMBULATORY CARE FACILITIES; APPOINTMENTS AND SCHEDULES; CARDIOVASCULAR NURSING; FEMALE; GROUP PROCESSES; HEART FAILURE; HUMANS; MALE; MIDDLE AGED; PATIENT CARE TEAM; PATIENT READMISSION; SELF CARE;

EID: 84989321768     PISSN: 08894655     EISSN: 15505049     Source Type: Journal    
DOI: 10.1097/JCN.0000000000000255     Document Type: Article

References (81)

1. Heidenreich PA, Albert NA, Allen LA, et al. Forecasting the impact of heart failure in the United States. Circ Heart Fail. 2013;6(3):606-619.
2. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013 23;309(4):355-363.
3. Go AS, Mozaffarin D, Roger VL, et al. Heart disease and stroke statistics V 2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-e292.
4. Dickson VV, Riegel B. Are we teaching what patients need to know? Building skills in heart failure self-care. Heart Lung. 2009;38(3):253-261.
5. Coffey RM, Misra A, Barrett M, Andrews RM, Mutter R, Moy E. Congestive heart failure: who is likely to be readmitted? Med Care Res Rev. 2012;69(5):602-616.
6. Reeder KM, Ercole PM, Peek GM, Smith CE. Symptom perceptions and self-care behaviors in patientswho self-manage heart failure [published online ahead of print 2013]. J Cardiovasc Nurs. doi:10.1097/JCN.0000000000000117.
7. Gheorghiade M, Vaduganathan M, Fonarow GC, Bonow RO. Rehospitalization for heart failure: problems and perspectives. J Am Coll Cardiol. 2013;61(4):391-403.
8. Sochalski J, Jaarsma T, Krumholz HM, et al. What works in chronic care management: the case of heart failure. Health Aff (Millwood). 2009;28(1):179-189.
9. Rich MW. Heart failure disease management programs: efficacy and limitations. Am J Med. 2001;110(5):410-412.
10. Smith CE, Piamjariyakul U, Wick J, et al. Multidisciplinary group clinic appointments: the Self-Management and Care of Heart Failure (SMAC-HF) Trial. Circ Heart Fail. 2014;7:888-894.
11. Bodenheimer T, Wagner E, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model. JAMA. 2002;288(15):1909-1914.
12. Shortell SM, Schmittdie J, Wang MC, et al. An empirical assessment of high-performing medical groups: results from a national study. Med Care Res Rev. 2005;62(4):407-434.
13. Levine MD, Ross TR, Balderson BH, Phelan EA. Implementing group medical visits for older adults at group health cooperative. J Am Geriatr Soc. 2010;58(1):168-172.
14. Lin A, Cavendish J, Boren D, Ofstad T, Seidensticker D. A pilot study: reports of benefits from a 6-month, multidisciplinary, sharedmedical appointment approach for heart failure patients. Military Medicine. 2008;173(12):1210-1213.
15. Grady KL, Dracup K, Kennedy G, et al. Team management of patients with heart failure: a statement for healthcare professionals from the Cardiovascular Nursing Council of the American Heart Association. Circulation. 2000;102(19): 2443-2456.
16. Houck S, Kilo C, Scott J. "Group Visits 101." Family Practice Management. 2003. http://www.aafp.org/fpm/20030500/66grou.html. Accessed December 9, 2013.
17. Glasgow RE, Davis CL, Funnell MM, Beck A. Implementing practical interventions to support chronic illness self-management. Jt Comm J Qual Saf. 2003;29(11):563-574.
18. Masley S, Phillips S, Copeland JR. Group office visits change dietary habits of patients with coronary artery disease-the Dietary Intervention and Evaluation Trial (D.I.E.T.). J Fam Pract. 2001;50(3):235-239.
19. Bartley KB, Haney R. Shared medical appointments: improving access, outcomes, and satisfaction for patients with chronic cardiac diseases. J Cardiovasc Nurs. 2010;25(1):13-19.
20. Watts SA, Gee J, O'Day ME, et al. Nurse practitioner-led multidisciplinary teams to improve chronic illness care: the unique strengths of nurse practitioners applied to sharedmedical appointments/group visits. J Acad Nurse Pract. 2009;21: 167-172.
21. Wagner EH, Grothaus LC, Sandhu N, et al. Chronic care clinics for diabetes in primary care: a system-wide randomized trial. Diabetes Care. 2001;24(4):695-700.
22. Hersh AM, Masoudi FA, Allen LA. Postdischarge environment following heart failure hospitalization: expanding the view of hospital readmission. J Am Heart Assoc. 2012;2(2): e000116. doi:10.1161/JAHA.113.000116.
23. Coleman EA, Grothaus LC, Sandhu N, Wagner EH. Chronic care clinics: a randomized controlled trial of a new model of primary care for frail older adults. J Am Geriatr Soc. 1999; 47(7):775-783.
24. Scott JC, Conner DA, Venohr I, et al. Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: a 2-year randomized trial of the cooperative health care clinic. J Am Geriatr Soc. 2004;52(9):1463-1470.
25. Beck A, Scott J, William P, et al. Randomized trial of group outpatient visits for chronically ill older HMO members: the Cooperative Health Care Clinic. J AmGeriatr Soc. 1997; 45(5):543-549.
26. Wilkes RM, Dukes KR, Feagles LL, Leong D, Allen GL. Kaiser Permanente's approach to congestive heart failure in South San Francisco. J Clin Outcomes Manage. 1999;6(5): 37-40.
27. Wakefiled BH, Boren SA, Groves PS, Conn VS. Heart failure caremanagement programs review of study interventions and meta-analysis of outcomes. J Cardiovasc Nurs. 2013;28(1): 8-19.
28. Glasgow RE, Funnell MM, Bonomi AE, Davis C, Beckman V, Wagner EH. Self-management aspects of the improving chronic illness care breakthrough series: implementation with diabetes and heart failure teams. Ann Behav Med. 2002; 24(2):80-87.
29. Powell LH, Calvin JE Jr, Mendes de Leon CF, et al. The Heart Failure Adherence and Retention Trial (HART): design and rationale. Am Heart J. 2008;156(3):452-460.
30. Kasper EK, Gerstenblith G, Hefter G, et al. Randomized trial of the efficacy of multidisciplinary care in heart failure outpatients at high risk of hospital readmission. J Am Coll Cardiol. 2002;39(3):471-480.
31. Paul S, Yehle KS, Wood K, Wingate S, Steg B. Implementing shared medical appointments for heart failure patients in a community cardiology practice: a pilot study. Heart Lung. 2013;42(6):456-461.
32. Mohler D, Schultz KF, Altman D. CONSORT Group (Consolidated Standards of Reporting Trials). The CONSORT Statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA. 2001; 285(15):1987-1991.
33. Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000;35(5):1245-1255.
34. McCullough PA, Philbin EF, Spertus JA, Sandberg KR, Sullivan RA, Kaatz S. Opportunities for improvement in the diagnosis and treatment of heart failure. Clin Cardiol. 2003; 26(5):231-237.
35. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for themanagement of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;15;62(16):e147-e239.
36. Bowden K, Fitzgerald SA, Piamjariyakul U, et al. Comparing patient and nurse specialist reports of causative factors of depression related to heart failure. Perspect Psychiatr Care. 2011;47(2):98-104.
37. McCann J, Blanchard Hills E, Zauszniewski JA, Smith CE, Farran CJ, Wilkie DJ. NIH SBIR project outcomes: home care self-management DVD series wins the international health media education award. West J Nurs Res. 2010;33(14):109-113.
38. National Institutes of Health. Turning discovery into health. Clear Communication: aNIHhealth literacy initiative. 2013. http://www.nih.gov/clearcommunication/. Accessed September 1, 2014.
39. Smith CE, Koehler J, Moore J, Blanchard E, Ellerbeck E. Testing videotape education for heart failure. Clin Nurs Res. 2005;14(2):191-205.
40. Russell C, Smith C, Ellerbeck E, et al. Self-Management and Care of Heart Failure Through Group Clinics (SMAC-HF): a nurse practitioner facilitated multidisciplinary group clinic. Paper presented at: American Association of Heart Failure Nurses (AAHFN) Conference; June 26-28, 2008; Boston, MA.
41. Kumar A, Dalton K, Vacek JL, Ellerbeck EF, Smith CE. Methodology of Self Management and Care of Heart Failure through group trial (SMAC-HF). Poster presentation at Quality of Care and Outcomes Research, Scientific Session American Heart Association;May 8, 2008; Washington, DC.
42. Blanchard E. Robert Wood Johnson Foundation transitions to better care: innovations in care transitions and discharge (top 100 videos in national presentation on care transitions and reducing readmissions). Washington DC: Robert Wood Johnson Foundation, Live Webcast. February 13, 2013.
43. Wakefield BJ, Boren SA, Groves PS, Conn VS. Heart failure care management programs: a review of study interventions andmeta-analysis of outcomes. J Cardiovasc Nurs. 2013;28:8-19.
44. Greenberg B. Acute decompensated heart failure-treatments and challenges. Circ J. 2012;76(3):532-543.
45. Lam C, Smeltzer SC. Patterns of symptom recognition, interpretation, and response in heart failure patients: an integrative review. J Cardiovasc Nurs. 2013;28(4):348-359.
46. Gustafsson F, Arnold JM. Heart failure clinics and outpatientmanagement: review of the evidence and call for quality assurance. Eur Heart J. 2004;25:1596-1604.
47. Ettner SL, Kotlerman J, Afifi A, et al. An alternative approach to reducing the costs of patient care? A controlled trial of the multi-disciplinary doctor-nurse practitioner (MDNP) model. Med Decis Making. 2006;26(1):9-17.
48. Scott LD, Setter-Kline K, Britton AS. The effects of nursing interventions enhancemental health and quality of life among individuals with heart failure. Appl Nurs Res. 2004;17: 248-256.
49. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48:1527-1537.
50. Gallagher R, Luttik ML, Jaarsma T. Social support and selfcare in heart failure. J Cardiovasc Nurs. 2011;26:439-445.
51. Watts SA, Gee J, O'Day ME, et al. Nurse practitioner-led multidisciplinary teams to improve chronic illness care: the unique strengths of nurse practitioners applied to sharedmedical appointments/group visits. J Acad Nurse Pract. 2009; 21:167-172.
52. Yehle KS, Sands LP, Rhynders PA, Newton GD. The effect of shared medical visits on knowledge and self-care in patients with heart failure: a pilot study. Heart Lung. 2009;38:25-33.
53. Roberts J, Brown GB, Streiner D, et al. Problem-solving counselling or phone-call support for outpatients with chronic illness: effective for whom? Can J Nurs Res. 1995;27(3): 111-137.
54. Piamjariyakul U, Russell C, Smith CE, Werkowitch M, Elyachar A. The feasibility of a telephone coaching program on heart failure home management for family caregivers. Heart Lung. 2013;42(1):32-39.
55. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147-e239. doi:10.1016/j.jacc.2013.05.019.
56. Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States. Circ Heart Fail. 2013;6:606-619.
57. Stauffer BD, Fullerton C, Fleming N, et al. Effectiveness and cost of a transitional care program for heart failure. Arch Intern Med. 2011;171(14):1238-1243.
58. Naylor MD, Bowles KH, McCauley KM, et al. High-value transitional care: translation of research into practice [published online ahead of print March 16, 2011]. J Eval Clin Pract. doi:10.1111/j.1365-2753.2011.01659.x.
59. Alspach GJ. Slowing the revolving door of hospitalization for acute heart failure. Crit Care Nurse. 2014;34(1):8-12.
60. Petterson SM, Liaw WR, Phillips RL, Rabin DL, Meyers DS, Bazemore AW. Projecting US primary care physician workforce needs: 2010-2025. Ann Fam Med. 2012;10(6):503-509.
61. Falk H, Ekman I, Anderson R, Fu M, Granger B. Older patients' experiences of heart failure: an integrative literature review. J Nurs Scholarsh. 2013;45(3):247-255.
62. Albert N, Fonarow G, Yancy C, et al. Influence of dedicated heart failure clinics on delivery of recommended therapies in outpatient cardiology practices: findings from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF). Am Heart J. 2010; 159(2):238-244.
63. Smith CE, Piamjariyakul U, Wick J, et al. Multidisciplinary group clinic appointments: the Self-Management and Care of Heart Failure (SMAC-HF) Trial. Circ Heart Fail. 2014;7: 888-894.
64. Piamjariyakul U, Yadrich DM, Russell C, et al. Patients' annual income adequacy, insurance premiums and out-ofpocket expenses related to heart failure care. Heart Lung. 2014;43(5):469-475.
65. Housden L, Wong ST, Dawes M. Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis. CMAJ. 2013;185(13):E635-E644.
66. Lavoie JG, Wong ST, Chongo M, Browne AJ, MacLeod ML, Ulrich C. Group medical visits can deliver on patient-centered care objectives: results froma qualitative study.BMC Health Serv Res. 2013;29:13:155.
67. Litchman JH, Froelicher ES, Blumenthal JA. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. 2014;129(12):1350-1369.
68. Centers for Medicare and Medicaid Services (CMS). Reporting hospital quality data for annual payment update. U.S. Department of Health & Human Services. 2010. https://www.cms.gov/HospitalQualityInits/08-HospitalRHQDAPU.asp. Accessed February 25, 2015.
69. Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000;35(5):1245-1255.
70. Lee CS, Lyons KS, Gelow JM, et al. Validity and reliability of the European Heart Failure Self-care Behavior Scale among adults from the United States with symptomatic heart failure. Eur J Cardiovasc Nurs. 2013;12(2):214-218.
71. Jaarsma T, Arestedt KF, Mrtensson J, Dracup K, Str Pmberg A. The European Heart Failure Self-care Behavior scale revised into a nine-item scale (EHFScB-9): a reliable and valid international instrument. Eur J Heart Fail. 2009;1(1):99-105.
72. Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333:1190-1195.
73. Pfeffer MA, Swedberg K, Granger CB, et al. Effects of candesartan on mortality and morbidity in patientswith chronic heart failure: the CHARM-Overall programme. Lancet. 2003; 362(9386):759-766.
74. Takeda A, Taylor SJ, Taylor RS, Khan F, Krum H, Underwood M. Clinical service organization for heart failure. Cochrane Database Syst Rev. 2012;9:CD002752. doi:10.1002/14651858.CD002752.pub3.
75. US Department of Health and Human Services. Understanding HIPAA Privacy. Office for Civil Rights. http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html. Accessed October 15, 2009.
76. Houts PS, Nezu AM, Nezu CM, Bucher JA, Lipton A. American College of Physician'sHome Care Guide for Cancer: How to Care for Family and Friends at Home. Philadelphia, PA: American College of Physicians; 1994.
77. Toseland R, Rivas R. An introduction to group work practice. 5th ed. Needham Heights, MA: Allyn & Bacon; 2005.
78. Roberts J, Brown GB, Streiner D, et al. Problem-solving counselling or phone-call support for outpatientswith chronic illness: effective for whom? Can J Nurs Res. 1995;27(3): 111-137.
79. Heisler M, Halasyamani L, Cowen ME, et al. Randomized controlled effectiveness trial of reciprocal peer support in heart failure. Circ Heart Fail. 2013;6(2):246-253.
80. Smith CE, Leneerts M, Gajewski B. A systematically tested intervention to manage a common adverse reactive depression. Nurs Res. 2003;52(6):401-409.
81. MacMahon KH, Lip GY. Psychological factors in heart failure: a review of the literature. Arch Intern Med. 2002;162: 509-516.