Just-in-time evidence-based e-mail "Reminders" in home health care: Impact on patient outcomes

Objective. To assess the impact and cost-effectiveness of two information-based provider reminder interventions designed to improve self-care management and outcomes of heart failure (HF) patients. Data Sources/Study Setting. Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF. Study Design. Patients were treated by nurses randomly assigned to usual care or one of two intervention groups. The basic intervention was an e-mail to the patient's nurse highlighting six HF-specific clinical recommendations. The augmented intervention supplemented the initial nurse reminder with additional clinician and patient resources. Data Collection. Patient interviews were conducted 45 days post admission to measure self-management behaviors, HF-specific outcomes ( Kansas City Cardiomyopathy Questionnaire-KCCQ), health-related quality of life (EuroQoL), and service use. Principal Findings. Both interventions improved the mean KCCQ summary score (15.3 and 12.9 percent, respectively) relative to usual care ( p <= .05). The basic intervention also yielded a higher EuroQoL score relative to usual care ( p <= .05). In addition, the interventions had a positive impact on medication knowledge, diet, and weight monitoring. The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes. Conclusions. This study demonstrates the positive impact of targeting evidence-based computer reminders to home health nurses to improve patient self-care behaviors, knowledge, and clinical outcomes. It also advances the field's limited understanding of the cost-effectiveness of selected strategies for translating research into practice.