Program Evaluation
Because the self-care college is one of several initiatives being implemented by NMHS with a focus on reducing readmissions for CHF patients, it is difficult to identify the specific effect of the self-care college on readmissions. However, since implementation in 2011, we have seen a relative rate reduction in CHF readmissions of approximately 23%, and a reduction in the observed to expected CHF readmissions ratio from 0.90 to 0.70.
In addition, referrals have steadily increased since the program began, which suggests that physicians are confident in the program and its ability to improve outcomes.
Beyond the quantifiable measures available to us, comments from patients indicate that the self-care college is improving the quality of life for many of our patients. Two patients noted the following:
“I felt like I wasn’t just thrown out there by myself...I was scared because I didn’t know anything about this disease. The program let me know I wasn’t alone.”
“I eat much differently. I am learning to eat less and eat the right foods...I check my blood sugar every day now, and I weigh myself every day. I know if I weigh more than 244 pounds, I need to call someone.”
While patient and physician feedback has been very positive as far as the effectiveness in teaching patients important self-care skills, we discovered another benefit: not only does the self-care college give patients hands-on practice with skills they will need and the opportunity to ask questions, the team has an opportunity to observe patients actually performing self-care activities, ask the patient questions about how they will follow their discharge instructions, and evaluate whether they are ready to be discharged. Given the distances that many of these patients travel to receive care in the hospital, having insight into their capability prior to discharge is an important advantage.
For example, a patient completing the weight module was having difficulty reading the numbers on the scales due to poor visual acuity, which had not been otherwise noted in his hospital records. The team was able to fit him for a scale with large numbers. In other cases, we have found patients who are unable to identify low-sodium foods. To help them meet dietary guidelines, the dietitian uses a food prop to show them how to read and understand the Nutrition Facts label and then discusses alternative food choices with them. At the medication station, patients bring in all the medications they are currently taking and are asked to identify when, how, and why they take each medication. Frequently, we find that patients do not understand the instructions on the label or that they have duplicate medications because one is a generic and another is a brand name. We can provide the patient with a medication planner that helps ensure their medications are taken properly.
Lessons Learned
As with any new initiative, the self-care college team learned important lessons throughout the implementation process. Chief among these was that flexibility is critical to success. We listened to feedback from patients, physicians, and hospital staff and modified the program to ensure that it was integrated as seamlessly as possible into everyone’s schedule. Feedback was obtained through a variety of methods, including medical staff meetings, discussions with patients and their family members, and feedback from Nurse Link coaches. Feedback led to a number of changes, including development of the mobile self-care college and changing the timing from the day of discharge to the day prior to avoid conflicts with other day-of-discharge activities.