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Differences in Education, Knowledge, Self-Management Activities, and Health Outcomes for Patients with Heart Failure Cared for Under the Chronic Disease Model: The Improving Chronic Illness Care Evaluation
Baker DW, Asch SM, Keesey JW, Brown JA, Chan KS, Joyce G, Keeler EB. J Card Fail, 2005 Aug; 11(6):405-13.

Objective: We sought to determine whether participation in the Institute of Healthcare Improvement Breakthrough Series (IHI BTS) led to better communication, education, knowledge, and self-management skills based upon direct reporting from patients.

Study Design: We conducted a quasi-experiment in 4 organizations participating in the IHI BTS for CHF (participants) in 1999-2000 and 4 comparable control organizations (controls). Participating organizations sent teams to three IHI meetings designed to facilitate major, rapid changes in CHF care based on the Chronic Care Model. Participating organizations provided a registry of patients; patients were interviewed by telephone approximately one year after the IHI BTS regarding provider-patient communication, education received, objective knowledge of CHF and self-management, self-management behaviors, satisfaction, and quality of life. The statistical significance of differences between groups was determined with multivariate methods, adjusting for demographics, socioeconomic status, coronary artery disease, previous revascularization, physician specialty, and study site.

Population Studied: Of the 781 patients who completed the survey 62% were age 65 or older, 52% were female, 71% were white, and 66% had a history of coronary artery disease.

Principle Findings: Patients in the participant group were more likely to report that their doctor and nurse 1) gave them choices and options about their treatment, 2) gave them confidence in their ability to make changes in their life to control their heart failure, and 3) regularly reviewed how they were doing managing all aspects of their condition (p < 0.01 for all). Patients in the participant group were more likely to report having received education about lifestyle modifications and self-monitoring; e.g., 86.5% of patients in the participant group reported being told to weigh themselves daily and record their weight compared to 34.0% of controls (p < 0.01). Patients in the participant group were approximately twice as likely as control patients to say that someone with heart failure should check his weight at least several times per week (81.9% versus 43.5%, p < 0.01), and they were more likely to know that swelling of the legs and ankles, waking up at night short of breath, and weight gain were signs of worsening heart failure (p < 0.01). Participant patients were more likely than controls to have a scale at home (adjusted percentages 92.1 versus 77.7%, respectively; p = 0.002), and 66.3% of patients in the participant group said they monitored their weight every day compared to 32.9% of control patients (p < 0.001). However, there were no significant differences in quality of life between the two groups.

Conclusions: Participation in the IHI BTS was associated with better communication, education, knowledge, and self-management skills.

Presented at the AcademyHealth meeting by David Baker, Northwestern University, at the panel on Does Participation in Collaborative Quality Improvement Programs Improve Care for Patients with Chronic Illness, 3:00 - 4:00 pm, June 6, Chair: Emmett Keeler, RAND