Clinical InvestigationRandomized Controlled Trial of Telephone Case Management in Hispanics of Mexican Origin With Heart Failure
Section snippets
Methods
Two bilingual/bicultural Mexican-American registered nurses with special training in HF provided the intervention. Telephone case management was hypothesized to decrease hospitalizations (acute care use) and improve HRQL and depression. Heart failure rehospitalization was the primary outcome variable. Other outcome variables were all-cause hospitalizations, days in the hospital (HF and all-cause), multiple readmissions (more than 1 in 3 or 6 months), acute care costs (HF and all-cause), and
Sample
With repeated measures, a sample size of 63 per group was estimated to provide at least 80% power at the 0.05 significance level to detect a small to medium effect of the intervention on HF rehospitalizations; a moderate effect could be detected with 55 per group.16 Self-identified Hispanics were identified at 2 participating community hospitals close to the US-Mexico border. Patients hospitalized with a primary or secondary diagnosis of HF, living in the community (ie, not institutionalized)
Results
The sample was elderly (72 ± 11 years), 54% female, married (60%), and poorly educated (78.4% with less than a high school education). More than half (55%) of the patients were entirely unacculturated into US society (Table 1, Table 2). Eighteen (13.4%) patients had an event (eg, HF rehospitalization or death) in the first month. Two patients had an event (1 HF rehospitalization and 1 death) before the nurse case manager could contact them or their family.
No significant group differences were
Discussion
Telephone case management provided by bilingual/bicultural registered nurses decreased acute care resource use in the intervention group, at least initially, but the difference did not reach statistical significance. These results differ from our prior study of this intervention.14 Both studies took place in the same community, with most patients enrolled from the same hospital. Both studies weaned patients from the intervention at about the same rate over the 6 months of the study. There were
Acknowledgment
The authors gratefully acknowledge Sophia Jimenez for data collection, Belia Gastelum and Lisa Costello for providing the intervention, and the administrative support provided by Sharp HealthCare and Scripps Health in San Diego, CA.
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Funded by an outcomes research grant from the American Heart Association.