Home Health Care Improves Perceived Quality of Life for Heart Disease Patients
CHICAGO -- A survey by Duke University Medical Center researchers has found that heart disease patients who receive home visits by health care personnel after hospital discharge reported better quality of life than those who received no visits.
While the researchers are continuing their studies to determine whether this perception of improved quality of life translates into better long-term outcomes or health care savings, they do believe the results offer another encouraging strategy for improving outcomes for heart disease patients.
The results of the Duke survey were presented today (March 30, 2003) at the 52nd annual scientific sessions of the American College of Cardiology by Barbara Lytle. The survey was supported by a grant from the U.S. Agency for Healthcare Research and Quality (AHRQ).
"There is little evidence in the scientific literature that supports a positive effect on the quality of life of home health care in heart patients after their hospitalization," Lytle said. "The results of our survey set the stage for further analysis of the specific benefits of home health care."
For home health care, either a nurse or other health care provider makes regularly scheduled visits to the patient's home to check on recuperation and/or to provide therapy or treatment.
In their analysis, the Duke researchers worked with two East Coast managed care organizations (MCOs) and surveyed 1,298 members who had been recently hospitalized for coronary artery disease. For analyses, they categorized the patients into four groups based on their primary diagnosis or treatment in the hospital -- unstable angina, heart attack, angioplasty or coronary artery bypass surgery.
Patients were contacted approximately nine months after discharge from the hospital and were asked to complete a questionnaire that included the SF-36 Reported Health Transition scale. The SF-36 is a commonly used survey instrument that contains 36 questions designed to yield insights into how patients perceive their health status and functional abilities. This survey is often used to measure how patients perceive their quality of life, the researchers said. The surveys were augmented by electronic records obtained from the MCOs documenting the medical services that patients received following their hospitalization.
"In one area, the results were very surprising," said Elizabeth DeLong, Ph.D., senior member of the Duke team. "We didn't expect home health care to be an influential factor in how patients felt about their recovery. But it was, especially for the heart attack and bypass patients."
Specifically, 34 percent of heart attack patients who received home health care reported that their health status was "much better," compared to 19 percent who didn't. Bypass patients who received home health care felt "much better" 49 percent of the time, compared to 45 percent for those who didn't. There was no difference among unstable angina patients.
"However, only 21 percent of angioplasty patients receiving home health care felt 'much better,' compared to 29 percent who did not receive the home care," DeLong explained. "This is a very interesting finding, one which needs further exploration. For one thing, fewer angioplasty patients routinely receive home health care. Another possible explanation is that it is not uncommon for angioplasty patients to require repeat procedures, while that is uncommon for surgery patients over the short-term."
The researchers point out that the patient group they studied was not necessarily representative. Since the patients are covered by a managed care organization, they tend to be younger and of working age, and not the older population that would be seen in MediCare, for example. However, the insights gained by this and future studies are of great interested to AHRQ and insurers, who must make decisions on how to treat their members, said the researchers.
"We do know that in general, people who feel better about themselves and their functional abilities will be more compliant with their therapies," Lytle said. "Conversely, those who have a more negative outlook on their quality of life tend not to be."
The Duke team is continuing to analyze the patient information provided by the managed care organizations to measure such factors as repeat visits to a physician or the hospital, repeat procedures or continued symptoms during the nine-month period. They plan to correlate that information with the patients' perception of quality of life.
They also plan an economic analysis to determine whether the investment in home health care yields long-term savings in health care utilization. According to the researchers, approximately one out of every eight U.S. heart disease patients receives some sort of home health care after discharge from the hospital.
Other members of the Duke team were Laura Coombs, Ph.D., Gregory Shook, Patricia Cowper, Ph.D., Karen Alexander, M.D., Eric Peterson, M.D., M.P.H., and Daniel Mark, M.D., M.P.H.