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Effect of nurse-implemented transitional care for Chinese individuals with chronic heart failure in Hong Kong : A randomized controlled trial
Yu, Doris S. F. Lee, Diana T. F. Stewart, Simon Thompson, David R. Choi, Kai-Chow Yu, Cheuk-Man
Yu, Doris S. F.
Lee, Diana T. F.
Stewart, Simon
Thompson, David R.
Choi, Kai-Chow
Yu, Cheuk-Man
Abstract
Objectives: To determine the effect of nurse‐implemented transitional care (TC) on readmission and mortality rates in Chinese individuals with chronic heart failure (CHF) in Hong Kong.
Design: Single‐center randomized controlled trial of TC versus usual care (UC).
Setting: University‐affiliated hospital in Hong Kong.
Participants: Hospitalized Chinese individuals with CHF (N = 178; aged 78.6 ± 6.9, 45% male).Measurements: The TC group received a predischarge visit, two home visits, and then regular telephone calls over 9 months to provide self‐care education and support, optimized health surveillance, and facilitation in use of community services. Primary endpoints were event‐free survival, all‐cause hospital readmission, and mortality during the 9‐month follow‐up. Secondary endpoints were length of hospital stay, self‐care, and health‐related quality of life (HRQL). Data were analyzed using survival analysis and generalized estimating equations, following an intention‐to‐treat principle.
Results: Survival analysis indicated no significant differences in event‐free survival, hospital readmission, or mortality between the TC and UC groups, although the TC group had a lower hospital readmission rate at 6 weeks (8.1% vs 16.3%, P = .048) and lower mortality at 9 months (4.1% vs 13.8%, P = .03). The TC group also had a shorter hospital stay (P = .006) and significantly better self‐care and HRQL. Because of attrition, sensitivity analyses were conducted to examine whether the intention‐to‐treat assumption affected the results. Per‐protocol population analyses (hazard ratio (HR) = 0.40, 95% confidence interval (CI) = 0.17–0.93) and worst‐case‐scenario analysis (HR = 0.44, 95% CI = 0.25–0.77) suggested a lower mortality risk in the TC group.
Conclusion: The translation of individual‐centered nurse‐implemented TC to the Chinese culture and healthcare context of Hong Kong appears beneficial.
Keywords
Date
2015
Type
Journal article
Journal
Journal of the American Geriatrics Society
Book
Volume
63
Issue
8
Page Range
1583-1593
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled