Utilization for congestive heart failure education program - Research Proposal Example

?Running head: Utilization Research for Congestive Heart Failure Education Program Utilization Research for Congestive Heart Failure Education Program Insert Name       Insert Grade Course Insert Tutor’s Name 9 January 2011 Executive Summary Congestive Heart Failure (CHF) has been on the increase, especially when one analyzes the current statistics. Today, CHF has surpassed traditional illnesses like cancer as the largest and predominant illness that affects Americans. CHF is characterized by the failure of the heart to pump enough blood and supply for oxygen. Further, CHF is likely to occur when blood supply in the body is inadequate, especially when attached to the heart and this causes the patient to feel symptomatic. Different intervention strategies have been identified that can help in management and treatment of the CHF. Although different interventional strategies exist, there seems to be increase in readmission, and numbers of CHF continue to go up. This calls for identification and innovation of more suitable intervention strategies that give appropriate results. In this perspective, educational interventional strategies have been identified as the primary strategies that can be used to reduce prevalence of CHF. With education, patients, together with stakeholders involved, are likely to acquire knowledge, skills, tools, and experiences that in long-term are likely to be beneficial in promoting awareness of CHF, hence contributing to management. This research proposal provides for educational interventional strategy and explores the effectiveness of the strategy. In addition, planning, implementation, evaluation, and decision-making processes are evaluated and analyzed, hence their efficacy in contributing to success of educational programs. On overall, for educational programs to promote awareness about CHF, the research proposes for adoption of integrated educational interventional strategy that also facilitates consultation and participation. These aspects make educational interventional strategy appear as the most efficient way of addressing the rising cases of CHF. Utilization Research for Congestive Heart Failure Education Program Background Cases of the heart failing to perform effectively have become more prevalent and pronounced in the modern world. As a result, a medical condition known as heart failure, which is believed to affect many people in USA, has emerged (Heart Failure Society of America, 2011). Heart failure (HF) is today viewed to be an important public health issue that faces the health care system. Heart failure, popularly known as the congestive heart failure (CHF), can be described as a condition where the sufferer is unable to experience sufficient blood flow in the heart, which in turn makes it difficult to meet the physiological needs of the body (Chen and Zieve, 2011). Causes of heart failure are myriad but can be connected to issues of lifestyle and dietary, as well as medications. Although the prevalence of heart failure problems are today more pronounced in the society, it has been observed that majority of people who have been affected by the disease are still unaware of the condition (Heart Failure Society of America, 2011). This has largely been associated with lack of knowledge many sufferers have, where symptoms associated with the disease are mistaken for normal signs of advancing in the age (Heart Failure Society of America, 2011). For instance, HF is associated with signs like feeling tired and experiencing frequent short breath, which majority of older patients may think constitutes signs of their advancing age. Therefore, this calls for effective diagnosis, which will help in determining the disease in an individual and subsequently being able to determine the course of treatment and management of the disease. The prevalence of the disease is more pronounced in the modern world, and this has led to accelerated efforts aimed at identifying the best methods that can be used to treat and manage the medical condition. Problem Identification By the end of 2011, it was estimated that heart failure remains a medical condition that affect many people in USA and world today. According to reliable statistics, five million people in America irrespective of the age are affected with heart failure (Heart Failure Society of America, 2011). This represent about 2-4% of the population. The condition becomes more pronounced in individuals with advanced age where the rate is estimated to be about 6-8% (Hosenpud and Greenberg, 2007). As a result, heart failure has progressively become the most common medical condition, which results into more hospitalization in the USA today, thereby surpassing convectional medical cases such as the cancer. In terms of costs, heart failure is responsible for hospitalization of about one million incidents every year and this is estimated to cost more than $25 billion every year (Hosenpud and Greenberg, 2007). All studies undertaken reveal that, cases of heart failure in the larger American society are increasing hence the prevalence of the medical condition is likely to increase in absence of clear and concrete mitigation measures. Such incidences are likely to see increased number of patients being hospitalized thereby increasing costs associated with treatment and management of the disease in the near future. As it has been evidenced in numerous research works, heart failure patients constitute about 60% of hospital inpatient stay and this has financial, social, and psychological impacts (Bales and Ritchie, 2009). Readmission has become more prevalent, and this shows that treatment and management of heart failure is still poor. Moreover, it has been observed that, readmissions of heart failure patients contribute to poor compliance with regard to treatment and medication (Shils and Shike, 2006). In addition, readmission has been associated with increased lack of education to identify early symptoms especially among the aging patients, lack of access to quality care, inadequate understanding of postoperative guidelines, and other chronic illness (McCarthy and Young, 2008). Given that these have been identified as the most prevalent attributes associated with increased readmission, it should further be known that, aspects such as; the gender of the patient, socio-economic status and race may further explain the increased readmission of heart failure patients (Moser and Riegel, 2001). Reduced readmission of heart failure patients can be achieved if appropriate interventions are identified. Such interventions can include treatment interventions, palliative care intervention, disease prevention and management interventions, and many more. The selection of each intervention strategy is largely attached to the efficacy and appropriateness of the strategy in reducing cases of disease through declined readmissions in the hospitals. For a long time, treatment and management of heart failure problems has been achieved by adopting different interventions such as; modification of individuals’ lifestyles and dietary practices (Chen and Zieve, 2011). Other interventions have included administering medications as forms of treatments, and in related cases that are complicated; surgery has been undertaken (Chen and Zieve, 2011). Morganroth and Moore (1987) observe that CHF is a major growing public health problem and many factors can explain the increasing prevalence of CHF. As a result, the authors note that, the disease is responsible for about 10% to 15% deaths every year, a situation that is actually alarming (Morganroth and Moore, 1987). As a way or providing recommendations in dealing with the disease, the author observes that, there is an urgent need to carry out evaluation of the effects and future treatment strategies specifically on individual basis. The essence here is that, reduction in the number of CHF will contribute towards increasing the number of years the patients can leave and will relieve the society the greater costs associated with the treatment of the disease. What should be noted is that, as far as efforts of creating more treatment opportunities for the disease are laudable, there is need to look for more innovative prevention and management strategies, which can be said to have long-term disease management benefits. This therefore, calls for identification and implementation of measures that can prevent the development of CHF in future. Solution Description On overall, efforts have been directed at ensuring that best methods are innovated to help in effectively dealing with the disease. However, as the popularity and efficiency of these techniques become prevalent, it has been established that cases of heart failure continue to increase, a fact that calls for innovation and implementation of effective management strategies. One such innovative strategy is promotion of education programs, which are seen to be effective means of tackling the disease in the positive way (Craft-Rosenberg and Pehler, 2011). It is seen that if education programs can be designed in the most effective way, they constitute the best strategy to intervene in the medical condition. Effective educational programs can concentrate on educating patients and the larger public on CHF issues such as how to improve exercise performance, how to improve quality of life, and how to improve survival chances (Morganroth and Moore, 1987). Therefore, objectives attached to this can be identified to be greatly aimed: to reduce readmission rate, delay disease advancement, and improve survival rate especially among the older adults (Morganroth and Moore, 1987). As prevalence of heart failure cases become more pronounced in modern day world and calls for innovation of best prevention strategies become inevitable, it can be said that education strategies that also include awareness and counseling are the best strategies to be pursued. The developed research hypothesis is that, developing integrated education programs and awareness strategies constitute major steps in dealing effectively with heart failure cases. Therefore, this research proposes numerous ways and methods education programs can be developed and implemented. First, the education programs should be integrative in nature and capture the multi-disciplinary nature that accompany genesis of CHF. Next, effort will be made to create education programs that enhance awareness with regard to various aspects of CHF. For example, the programs should be able to address the epidemiology of CHF, etiology, prevalence and the related aspects. Therefore, patients and relevant stakeholders involved will be able to develop diverse knowledge about the disease. Furthermore, education programs to be developed and proposed by the research will largely be in languages that affected stakeholders can understand. The themes will be clear, explanations concisely presented, and all information well articulated. This will ensure that the delivery process and decoding procedures of the messages and information in education materials achieve intended objectives. Moreover, the entire process of education and awareness will be participative in nature, largely involving administrators, nursing professionals, patients, caregivers, family members, and relevant identified members. As a result, effective channels of communication will be critical in realizing the objectives of the entire process. Therefore, educational and awareness strategies to be adopted will address three main broad goals. The goals are to build and promote awareness for CHF and the related risk factors. The second objective will be to equip all the affected especially patients with necessary knowledge, skills and appropriate tools that can help them manage CHF more efficiently. Lastly, the third goal is premised on the desire to connect people involved to the health-related resources, which will enable them have opportunity to identify and know how to manage the disease in an easy way. In summary, it can be noted that, it is through education that promotion of wellness, prevention of CHF, and management of the disease can be realized in an interactive, relevant and empowering way that later benefits all the involved stakeholders (Rankin, Stallings, and London, 2005). Therefore, the strategy to be adopted will involve developing integrative and sustainable education and awareness programs that also encourage and facilitate counseling. Research Support The use of education interventional strategies to prevent, manage, and subsequently reduce cases of disease prevalence has been investigated by many researchers (Gochman, 1997). This position has initially been informed by the discovery that the convectional strategies of treatment have bore little fruits as more cases of disease and related deaths continue to increase, sometimes alarming the society. Education as a strategy to reduce readmission of patients suffering from numerous medical conditions has been found to be effective and essential aspect in ensuring patient care which later promote clinical stability. In order for education interventional strategies to be effective, they have been integrated with counseling strategies, which together promote awareness of medical conditions hence giving people opportunity to increase their management capacities. On overall, educational interventional strategies are regarded to empower patients and all stakeholders involved since they acquired critical knowledge, skills, and tools that become important in disease-symptoms identification, medication, lifestyle modification, and general treatment and management strategies. The Education Program-Benefit Matrix Research Intervention Benefits/Outcome Improvement Education Program Gochman (1997) Joint Commission Resource (2003) Pui (2006) Gulizia (2003) Educational intervention Education intervention -Education intervention Education intervention -prevent, manage, and reduce disease prevalence. -Reduce readmission of patients. -Promote clinical stability -Empower patients and stakeholders. -Enhance positive outcome. -prevent maladaptive behavior. -promote health habits. -Provide critical training to patients -Positive outcomes for CHF -readmission and cost reduce by 51%. -Compliance increase. -Integrate with counseling strategies. -increase awareness. -Increase participation and involvement. -Individualize the programs. -Enhance participation. -Develop clear goals. -Create clear plan. -Set achievable goals. -Integrate counseling. -Encourage collaboration among stakeholders. Health education programs have become popular strategies that are being adopted today in a way to prevent and manage chronic illness and related medical conditions. Patient and family education is perceived to be important especially in managing chronic illness, where the goals are always to promote safety among patients, enhance positive outcomes, and improve patients’ quality of lives (Joint Commission Resources, 2003). It is further observed that, patient education is characteristically important since it provide opportunity to improve patient’s health behaviors and the health status. When education is facilitated among the patients and key stakeholders, the patients and stakeholders are in a position to make informed decisions, specifically with regard to disease treatment, improve of outcomes, and being able to identify errors when they occur (Joint Commission Resources, 2003). For example, Pui (2006) observes that health education programs are designed in a way that they provide help in preventing or modifying maladaptive health behaviors. At the same time, the authors find health education programs to promote healthy habits among patients suffering from various illnesses. In most cases, health education programs are seen to be designed based on long-term good health promotion objectives, that later results into modification of patient’s behaviors and related stakeholders. Moreover, education programs are seen to provide training that is aimed at increasing protective health behaviors (Pui, 2006). In an attempt to establish the efficacy of education programs in promoting protective health behaviors among those suffering from diverse illness, Pui (2006) found that the programs were responsible for increased knowledge among the patients and close stakeholders like relatives, health providers, and many more. Moreover, patients after being introduced to education programs were found to adopt better-health practices that enhanced and improved their health conditions. Lastly, the author established that, patients and stakeholders who completed education program requirements were more informed and had capacity and ability to improve health-related decision-making abilities (Pui, 2006). Gulizia (2003) carried out research on the effectiveness of education and counseling programs in managing CHF. The authors established that education programs were responsible for positive outcomes among patients diagnosed with CHF. The author objectives for the study were to establish the link between education programs and the rate of readmission, rate of compliance, and rate of costs (Gulizia, 2003). At the end of the study, the authors were able to establish that by designing and implementing effective education programs, there was about 51% reduction in total admissions and reduced costs (Gulizia, 2003). Moreover, the study respondents reported better compliance with weighing and following a low-salt diet (Gulizia, 2003). Therefore, the authors concluded that, a clear and organized plan of patient education and counseling was critical to the achievement of optimal outcomes (Gulizia, 2003). Furthermore, in order for the education program to be successful, collaboration and input of multiple players is critical such as the nursing professionals, diet experts, pharmacists, physicians, and caretakers. The results of the study carried out by the authors can be interpreted to mean that, the overall goals of education and counseling should be designed largely to assist patients comply with the therapeutic regimen, maintain clinical stability, and improve the quality of life of the patients (Gulizia, 2003). On overall, an education program can be perceived to have numerous benefits that are related to the treatment, management, and improvement of illness among the population. Such benefits can be identified as follows: education programs increase the patient’s ability to cope and manage his or her health in the most productive way (Joint Commission Resources, 2003). Another benefit of education programs is that, it facilitates patients and families’ understandings with regard to health status, options, and consequences of care. The third benefit of education programs is reflected in the fact that, they largely encourage and help patients and other stakeholders in decision-making process (Joint Commission Resources, 2003). Other benefits of education programs can be identified as: they increase patients potential to follow health care plan; help patients learn behaviors that promote recovery and improve health,; increase patient confidence in their attempts for self-care; and lastly, decrease treatment complication (Joint Commission Resources, 2003). Implementation Plan The paramount objective of this research proposal is to evaluate how education programs can be used to prevent and manage heart failure problems among the patient in the country. Promotion of education and creation of awareness are perceived to constitute strategies that efficient and effective in achieving goals of reduction in readmission with regard to CHF. The aim therefore, is to design an effective educational program, which entirely concentrates on educating patients and the larger public on CHF issues such as how to improve exercise performance, how to improve quality of life, and how to improve survival chances. As it was noted, the designed program has to be integrative in nature and reflect multi-disciplinary nature, which is associated with epidemiology, etiology and development of CHF (Kirch, 2008). In other words, the education program has to address the multiple issues and needs of CHF and provide the diverse ways education goals and objectives can be facilitated (Weiner et al., 2003). The education program for CHF should be developed based on multiple aspects such as social, economic, cultural, religion, age, gender, and so on. The aim here is to build a comprehensive program that addresses multiple issues and needs (Chandramohan and Fallows, 2009). The education program will be based on a clear formulated plan, whereby the program will be created with clear goals to achieve, concise objectives, execution strategies, the target population, and learning aids to be incorporated. Before the program can be initiated, prior efforts will be made to study and evaluate both internal and external environments as they apply to patients and related stakeholders. This will be specifically necessary to minimize threats that may undermine the program while at same time maximizing opportunities for the success of the program. After this has been completed, lessons plans will be developed and the lessons plans will largely reflect key aspects of age, gender, propensity of individual illness, education, and cultural aspects. Lesson facilitators will have to be recruited and trained appropriately after thorough assessment and vetting has been conducted. The education plan to be developed will have three major components: General information about CHF, teachings on how to improve quality of life, and teaching on how to improve survival chances. General information section will largely incorporate information on epidemiology, etiology, development, diagnosis, and treatment. The second section on how to improve the quality of life will incorporate multiple educational strategies such as; counseling, behavioral changes, and lifestyle modification, that patients and related members can undertake in order to improve quality of life for the patients. The third section will incorporate education information on how to improve survival chances and this will include information such as; treatment, attitude change, seeking help, providing adequate care, and where to find help for the patients. Learning will be facilitated in different ways. Efforts will be made to individualize learning methods with the needs of demographic and related characteristics. Physical and online learning methods will be encouraged specifically with regard to suitability of each method with regard to capability of each patient. Audio and visual learning will be incorporated in the education program where at same time, both in-house and external learning will be encouraged. Electronic and print media will be utilized in this program. Moreover, in-house learning will be largely conducted by facilitators with specialized training and accredited by relevant bodies. Learning will be undertaken in sessions, ranging from hours to a number of days. In order to assess the effectiveness of learning process, after every topic, feedback instruments will be used to assess, and this will involve both verbal and written feedback comments. Effective communication, characterized in terms of interactive communication will be adopted in this education program (Moon, Mayes, Hutchinson, and Open University, 2002). Effective communication is largely seen to be necessary if the learning objectives are to be achieved. On overall, the learning process is aimed at long-term basis where the objective is to establish and promote knowledge acquisition among CHF patients and other stakeholders for long-term prevention and management of the disease. Evaluation Plan Evaluation can be considered as the ultimate exercise that ensures knowledge about the effectiveness; weakness, opportunities, and sustainability of the program are known (Fink, 2005). When a program is initiated, there is need to identify the key characteristics of the program in terms of success, failure, challenges, and outcome. Therefore, program evaluation become the avenue in which information is generated concerning programs’ effectiveness, interventions, outcomes, efficiency, and quality (Novick, Morrow and Mays, 2008). This research project will initiate evaluation of the education program in order to ascertain the above stated objectives. In so doing, it will utilize quantitative and qualitative evaluation tools. Quantitative tools or techniques provide estimates in terms of figures regarding the extent to attainment of education programs’ goals and objectives (Neary, 2002). On the other hand, qualitative techniques provide descriptions, which can be used to measure the level to which goals have been attained (Mashaba, 1994). The overall objectives and goals of the education will be evaluated. This will involve calculating the percentage estimate with regard to the number of patients and stakeholders attending and benefiting from the education program. In addition, calculated percentages of rate of reduced readmission in hospital, reduced number of deaths as a result of CHF, and many more will be established. At the same time, the number of lessons attended and administered to patients will be evaluated with the related response rate to each lesson. The rate at which behavior changes among patients will also be evaluated using qualitative measurement scales. Moreover, the attitude of patients towards the disease will be evaluated and this will involve ascertaining the level of medical adherence, willingness of patients to undertake physical exercises, the willingness to change diet, and further, the increased knowledge about CHF patients have gained. Given that resources will be used to attain the goals of this education program (Bastable, 2008), it will also be necessary to evaluate the cost, and expenses spent on the program issues in relation to attainment of goals and in relation to willingness of sponsors and donors to increase their sponsorship opportunities. Decision Making The developed education program strategy as was highlighted earlier reflects multi-disciplinary nature that incorporates identifying, treating, preventing, and managing CHF. It is a program that reflects aspects of inter-disciplinary hence, interdependence. Decision-making process is likely to be multi-directional and not uni-directional, which means different stakeholders are likely to be involved if the success of the program is to be realized. As CHF become an issue, it is clear that in future, efforts will have to be made in finding the best interventional strategies in preventing and managing the disease. Therefore, participative and collaborative decision-making approach should be encouraged (Zarate, 2008). Participation and promotion of divergent view expression should be the basis upon which future strategies should be developed in intervening in the prevention and management of CHF (Donnelly, 2011). Participative decision-making approach has the advantage of being enriched by diverse skills, perspectives, and experiences, which is likely to see generation of solutions that are more long-term sustainable. Another aspect regarding decision-making process in the future is that consultation and more research should be the basis upon which to generate solutions (Longest, 2004). Consultation should involve both internal and external stakeholders where the essence should be to achieve diverse views, positions, and models that are effective in making decisions. Internal consultations will ensure organization’s resources are well utilized and that little resistance is likely to be experienced. On the other hand, external consultation will largely to tap external experiences with regard to decision-making solutions. More research on the other hand, will be necessary since appropriate data will be available upon which decisions can be made. Such research work will provide the nature and experience of environment, thus enabling stakeholders to adopt the best decisions of ensuring management of CHF is realized effectively. Lastly, communication should be the primary foundation on which effective decisions are arrived at. For instance, there should be promotion of open communication that has little barriers. This will ensure all the concerned stakeholders give their views confidently which in turn can help in developing the best strategies or modification interventions in future. Conclusion Statistics indicate that cases of heart failures are on the increase and this seems to indicate convectional methods of intervention are not much effective. Therefore, this force concerned stakeholders to innovate and evaluate the appropriate interventional practices that can results into greater benefits. As this becomes the issue, it is evident that, preventing and managing CHF is likely to bear fruits when educational interventional strategies are adopted. Again, this requires adoption of integrated educational strategies in form of programs that address the needs of affected stakeholders comprehensively. 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Retrieved January 7, 2012, from http://books.google.com/books?id=Jirt1u6LIjgC&pg=PA139&dq=integrated+decision-making+in+education+program+for+chronic+illness&hl=en&sa=X&ei=viwKT7PCMMjj8APwstypAQ&ved=0CEsQ6AEwBDgU#v=onepage&q=integrated%20decision-making%20in%20education%20program%20for%20chronic%20illness&f=false. Read More