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Use of the Short Form 36 in a Primary Care Based Disease Management Program for Patients with Congestive Heart Failure

机译：充血性心力衰竭患者在基于初级保健的疾病管理计划中使用简短表格36

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While disease management has been described as an important strategy for the care of patients with congestive heart failure (CHF) in the managed care setting, little is known about the impact of this approach on overall health-related quality of life. In this study the Short Form 36 (SF-36) was administered to all patients entering CHF disease management at the time of program entry and at 1 year following entry. Scores on the eight subscales and the two composite scales were calculated and compared before and after. Patients were enrolled from a mixed-model health maintenance organization (HMO) with 34,740 Medicare+Choice enrollees residing in 38 counties in central and northeastern Pennsylvania. Two hundred sixty-eight continuously enrolled patients in an HMO-sponsored CHF disease state management program with completed baseline and follow-up SF-36 surveys were sampled. All patients entered into disease management received primary care based, nurse-directed education about CHF self-management including instruction on etiology of CHF, the importance of medication compliance, home care services if indicated, monitoring weight gain, increased understanding of the warning signs of worsening CHF, and coaching on strategies to contact a physician in a timely manner when CHF worsens. Nurses also facilitated for CHF guidelines among primary care physicians, including the need to obtain a baseline assessment of cardiac function, prescribe angiotensin I-converting enzyme (ACE) inhibitors and beta blockers when appropriate, and initiated appropriate specialist referral. Compared with enrollees who did not complete a pair of SF-36 surveys, the 268 respondents were younger and had a significantly higher rate of cardiac imaging as well as use of ACE inhibitors and beta blocker medications. Analysis of the SF-36 data revealed that three of the eight (Role Physical, General Health Perceptions, and Role Emotional) subscales increased in a statistically significant manner, as did the Mental Health Composite Score. No statistically significant declines in SF-36 scores were observed. Despite limitations to our study, we found disease management for patients with CHF can be associated with significant improvements in quality of life as measured by the SF-36. Compared with nonrespondents, respondents had a higher prevalence of cardiac imaging, ACE inhibitor use, and beta blocker medication use. Our findings are also limited by a lack of a control group with the possibility that the improvements we observed were unrelated to the disease management intervention. However, our findings and success with the use of this tool indicate the SF-36 can be an important part of the ongoing assessment of patients in a disease management program for CHF.
机译：虽然疾病管理已被描述为在管理式照护环境中对充血性心力衰竭（CHF）患者进行照护的重要策略，但对于这种方法对整体健康相关生活质量的影响知之甚少。在本研究中，在程序输入时和输入后1年内，对所有进入CHF疾病管理的患者都使用了Short Form 36（SF-36）。分别计算了八个子量表和两个综合量表的得分，并进行了比较。患者来自混合模型健康维持组织（HMO），宾夕法尼亚州中部和东北部38个县的34,740名Medicare + Choice入组者。在HMO赞助的CHF疾病状态管理程序中，有268例连续入选的患者已完成基线并随访了SF-36调查。所有进入疾病管理的患者均接受了以基础护理为基础的，由护士指导的有关CHF自我管理的教育，包括CHF病因学指导，药物依从性的重要性，家庭护理服务（如果有指征），监测体重增加，对CHF警告标志的了解增加CHF恶化，并在CHF恶化时指导及时与医生联系的策略。护士还为初级保健医生提供了CHF指南，包括需要获得心脏功能的基线评估，在适当时开具血管紧张素I转换酶（ACE）抑制剂和β受体阻滞剂的处方，并启动适当的专家转诊。与未完成SF-36调查的参加者相比，这268位受访者更年轻，心脏成像率更高，并且使用ACE抑制剂和β受体阻滞剂的人数更高。对SF-36数据的分析显示，八项（角色身体，总体健康知觉和角色情感）分量表中的三项以统计学上显着的方式增加，心理健康综合评分也是如此。观察到SF-36评分没有统计学上的显着下降。尽管我们的研究存在局限性，但我们发现CHF患者的疾病管理与SF-36可以显着改善生活质量有关。与无应答者相比，应答者的心脏成像，ACEI抑制剂和β受体阻滞剂药物使用率更高。由于缺乏对照组，我们的发现也受到局限，我们观察到的改善与疾病管理干预无关。然而，我们的发现和使用该工具的成功表明，SF-36可能是正在进行的CHF疾病管理计划中患者评估的重要组成部分。

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