Factors associated with poor self-management documented in home health care narrative notes for patients with heart failure.
Sena Chae, Jiyoun Song, Marietta Ojo and 8 others
PMID 35597164WHAT IT FOUND
Only 7.8% of home health heart failure patients had documented poor self-management.
Associated factors were younger age, male gender, diabetes, depression, smoking, impaired decision-making, disruptive behavior, longer stay, and shortness of breath with exertion.
Key findings
01The NLP algorithm identified documented poor self-management in 758 of 9,710 patients (7.8%) and 1178 of 15,948 episodes (7.3%).
02Unspecified poor self-management and poor diet adherence were the most common documented domains, while medication, exercise, missed care, and other self-care activities were rarely documented.
03In multivariate analysis, documented poor self-management was associated with younger age, male gender, longer home health stay, diabetes, depression, disruptive behavior, impaired decision-making, smoking, and shortness of breath with exertion.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The outcome was documentation of poor self-management in notes, not directly observed or confirmed self-management behavior. Clinicians may document inconsistently or use terms that the algorithm misses, so the 7.8% figure may understate or overstate true poor self-management. The NLP algorithm may miss information or misclassify notes. The data came from one home health agency in the Northeastern US, so findings may not apply to other home health settings. The study was retrospective and observational, so it shows associations, not causes, and it did not test whether targeting these factors improves heart failure outcomes. Most analyses were at episode level, and patients averaged 1.64 episodes, so the same patient could contribute multiple episodes.
Declared interests
The authors declared no competing interests. The paper is listed as supported by NIH and U.S. Public Health Service research support.
The easy way to misread this
Do not read the 7.8% figure as the true rate of poor self-management. It is the rate of poor self-management documented in home health notes, and the authors note that documentation may be inconsistent or missing.