Page 158 - Hospital Authority Convention 2018

Special Sessions
HOSPITAL AUTHORITY CONVENTION 2018

SS4.3 Translational Nursing and Its Applications 09:00 Theatre 2

A Transitional Care Programme on Self-care, Hospital Readmission and Mortality among Patients with Chronic
Heart Failure: Empirical Effects and Translational Challenges
Yu DSF
The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong

Aims
To determine the impact of nurse-implemented transitional care on readmission and mortality among Chinese patients with
chronic heart failure (CHF).

Methodology
This randomised controlled trial recruited a total of 178 Chinese older patients hospitalised with CHF from a regional hospital
in Hong Kong. The transitional care was conducted by a cardiac nurse, and included an in-hospital visit, two home visits
and then regular telephone calls over nine months to provide tailored self-care empowerment, optimised health surveillance,
prompt professional support and facilitation in community services utilisation. The control group received usual post-
discharge care. Primary endpoints were event-free survival, all-cause hospital readmission and mortality during the nine-
month follow-up. Secondary endpoints were length of hospital stay, self-care (maintenance, management, confidence and
knowledge) and health-related quality of life (HRQL). Data were analysed using survival analysis with Cox regression and
General Estimating Equations (GEE).

Results
The mean age of the subjects was 78.6±6.9 years, with 45% as male. There was no statistically significant difference in
event-free survival, hospital readmission or mortality between TC and UC groups, although the reduced mortality risk in
the TC group was close to reaching statistical significance [Adjusted HR = 0.45, 95% CI = 0.19 –1.05, p=0.066]. Sensitivity
analysis on the pre-protocol population regarding this primary outcome further suggested its survival benefit [Adjusted HR =
0.40; 95% CI = 0.17– 0.93, p = 0.033]. The TC group was associated with a shorter median length of hospital stay [TC 7days
(IQR=5 – 8 days) vs UC 13 days (IQR=7–18 days), p=0.006] and improved self-care and HRQL.

Conclusion
Despite no significant impact on event-free survival and hospital readmission, nurse-implemented TC demonstrated
significant reductions in recurrent hospital stay and improvements in self-care and HRQL among Chinese patients with CHF.
It may also have the potential to confer survival benefits.

Tuesday, 8 May 2018

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