Patient Activation in Acute Decompensated Heart Failure.
Shannon M Dunlay, Joan M Griffin, Margaret M Redfield and 1 others
PMID 27631119WHAT IT FOUND
Patients hospitalized with heart failure who felt less confident managing their care were more often discharged to a nursing home and were more likely to die within 30 days.
Activation was not linked to readmission or length of stay.
Key findings
01The odds of discharge to a skilled nursing facility increased 10% with each 1-point decrease in the activation score.
02Patients with the lowest activation level had a 6.4-fold higher risk of death within 30 days after discharge than patients with the highest two activation levels.
03Activation was not significantly associated with 30-day readmission or hospital length of stay.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational study, so it cannot show that low activation caused nursing home discharge or death. Only 302 of 375 approached patients agreed to participate, so those who declined may have been different. The study was done in one community, and readmissions to hospitals outside Mayo Clinic were not captured. In-hospital mortality was rare (7 patients, 2.3%), so the study had limited ability to detect an association with activation. Activation was measured during hospitalization for acute decompensation, which may make patients feel less in control than usual. The study did not test whether measuring activation or intervening to improve activation changes outcomes.
The easy way to misread this
Do not conclude that improving patient activation will reduce nursing home discharge or death. This was an observational study, and the authors state that low activation may reflect patients nearing the end of life rather than causing death.