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Noteworthy Publications

Structured automated calls are a feasible way to increase informal support for heart failure patients' self-care management

Heart failure is a leading cause of preventable hospitalization and death in VA. There are a number of steps patients at risk of heart failure can take to reduce their risk factors, including quitting smoking; lowering their cholesterol; controlling their blood pressure and blood sugar levels; limiting their alcohol intake; and getting regular exercise.

A number of studies have shown that better care management supported by health information technology can improve patients' outcomes—but that care managers in the real world are often overwhelmed by the need to monitor their patients and help them change their behaviors. A team led by Dr. John Piette of VA's Center for Clinical Management Research in Ann Arbor, Mich., studied a way to get Veterans and their care partners (adult children or friends living outside the Veteran's home but who are willing to help the Veteran manage his or her care) more involved in the process of reducing risk factors.

The researchers provided automated telephone assessment and behavior change calls to 372 Veterans with heart failure every week over 12 months. The calls included a recorded message, and each asked Veterans to respond to a number of questions either by using their touch tone keypad or their voice. Based on their responses, the Veterans received health information tailored to their needs.

Half of those Veterans had care partners, and the other half did not. The care partners participating in the study received structured and tailored reports by email, based on the results of the patients' automated calls. The feedback included information about what the patient reported, along with suggestions for how the care partner could help the Veteran with his or her self-care activities.

The team found that Veterans completed 89 percent of their weekly telephone assessments and reported very high satisfaction with the system, and with the care partner program in general. Older Veterans, including those age 75 and above, had higher call completion rates. The team concluded that structured automated calls are a feasible way to help patients manage their heart failure, and can effectively enhance scarce clinical resources. (Medical Care, March 1, 2013)

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