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Defining The Clinical Question - Essay Example

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Defining The Clinical Question Valerie Sanford RN, MSN, CRNP, AACC Duke University School of Nursing Dr. Deirdre Thornlow, PhD, RN, CPHQ September 22, 2011 Introduction Heart failure is a chronic condition that affects an estimated 5 million Americans. The one year survival rate has been estimated at 80-90% in patients classified as NYHA class I-II and 50-60% in NYHA class III-IV; which is more than breast cancer, ovarian cancer, and colon cancer…
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Download file to see previous pages Some studies have shown that education given to patients may be insufficient. Noncompliance with medication, diet, or symptom monitoring caused 15-64% of hospital readmissions. One way to combat these barriers is to design advanced practice nurse led heart failure clinics for outpatient management of heartfailure . Many studies have shown that heart failure clinics designed with advanced practice nurse post hospital follow-up improved patient education and compliance thus decreasing hospital readmissions (Paul 2008). The types of heart failure patient typically followed in advanced practice nurse led clinics are New York Heart Association Classifications II-IV. These patients were classified based on either echocardiography or radiography evidence of pulmonary congestion or signs or symptoms of heart failure. Background Despite advancements in the management of this debilitating condition, such as introduction of beta blockers, aldosterone antagonist, and angiotensin receptor blockers mortality and morbidity among heart failure patients remain high. Generally 25-50% of hospitalized patients will be readmitted within 6 months of discharge (Gustafsson, Schou et al. 2009). The most cited incidents for readmissions are noncompliance with drug therapy, poor compliance with dietary restrictions, fluid restrictions, and inadequate medical therapy (Paul 2008). Thus, it appears that the readmission and mortality rates of heart failure patients maybe the result of less than optimal approach by the patient and provider. In terms of mortality the Framingham Study showed that once patient was diagnosed with heart failure the 6 year mortality was 85% for men and 67% for women . Heart failure puts a significant health and financial burden on patient’s families and society. Estimated cost of heart failure in the US is over $35 million according to the American Heart Association. As we all know the incidence of heart failure increases with age. According to the center for disease control 70% of the people over the age of 60 have heart failure and the number is expected to rise (Ferguson 2008) . For instance in 2000 approximately 12.7% of the American population was 65 years of age or older. It is estimated in 2020 this number will rise to 16.5%. In an effort to reduce 30 day readmissions, mortality, and overall cost a growing number of hospitals and medical groups are forming evidenced based heart failure clinics to combat this epic problem. The population to be evaluated in this project are patient diagnosed with heart failure with either systolic or diastolic impairment that have recently been hospitalized, The purposed intervention is one week follow up post discharge in a nurse practitioner led heart failure clinic. The patients will then be monitored by nurse practitioner and MD . A comparison will then be made to those patients followed by an MD only . The outcome that is proposed is that patients followed in a nurse practitioner and MD collaborative heart failure clinic will have a decrease in 30 day readmission rates to the hospital . Clinical Question Does the addition of a nurse practitioner to a heart failure clinic reduce 30 day readmission rates for heart failure patients? Keywords: A medline search was conducted using the terms “ ...Download file to see next pagesRead More
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