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Registered nurse effect on long length of stay in the heart failure hospitalizations of African Americans

by Tremaine B. Williams, Pearman Parker, Milan Bimali, Maryam Y. Garza, Alisha Crump, Taiquitha Robins, Emel Seker, Ava Storey, Allison Purvis, Mya Tolbert, Anthony Drake, Taren Massey Swindle, Kevin Wayne Sexton

African Americans experience approximately 2.5 times more heart failure hospitalizations than Caucasians and the complexity of heart failure requires registered nurses to work in collaboration with other types of healthcare professionals. The purpose of this study was to identify care team configurations associated with long lengths of hospital stay in African Americans with heart failure hospitalizations and the related effect of the presence of registered nurses on their length of hospital stay. This study analyzed electronic health record data on the heart failure hospitalizations of 2,274 African American patients. Binomial logistic regression identified the association between specific care team configurations and length of stay among subgroups of African American patients. Of the significant team configurations, a Kruskal-Wallis H test and linear regression further assessed the team composition and the specific change in days associated with a one-unit change in the number of registered nurses on a patient’s care team. Six team configurations were associated with a long length of stay among all African Americans regardless of age, sex, rurality, heart failure severity, and overall health severity. The configurations only differed significantly in the proportion of registered nurses with respect to other care team roles. An increase in one additional registered nurse on a care delivery team was associated with an increase in length of stay of 8.4 hours (i.e., 504 minutes). Identifying the full range of social and technical care delivery tasks performed by RNs, and controlling for their effect on length of stay, may be a key strategy for reducing length of stay and explaining why these six configurations and RNs are associated with long LOS. The identification of these models can be used to support decision-making that optimizes the availability of patient access to high-quality care (e.g., clinical staffing and supplies).

Cost-consequence analysis of an e-health intervention to reduce distress in dementia carers: results from the iSupport randomised controlled trial

Por: Anthony · B. · Doungsong · K. · MacLeod · C. · Flynn · G. · Masterson-Algar · P. · Goulden · N. · Egan · K. · Jackson · K. · Kurana · S. · Hughes · G. · Innes · R. · Connaghan · J. · Proctor · D. · Ismail · F. A. · Hoare · Z. · Spector · A. · Stott · J. · Windle · G. · Edwards · R. T.
Objective

The use of e-health interventions has grown in demand due to their accessibility, low implementation costs and their potential to improve the health and well-being of people across a large geographical area. Despite these potential benefits, little is known about the cost-effectiveness of self-guided e-health interventions. The aim of the study was to compare the cost and consequences of ‘iSupport’, an e-health intervention to reduce mental health issues in dementia carers.

Design

A cost-consequence analysis (CCA) of a multi-centre, single-blind randomised controlled trial of iSupport. The CCA was conducted from a public sector (National Health Service, social care and local authority) perspective plus a wider societal perspective. Delivery costs of iSupport were collected using a bottom-up micro-costing approach.

Setting

352 participants were recruited from three centres in England, Wales and Scotland.

Participants

Participants eligible for inclusion were adults over the age of 18 years who self-identified as an unpaid carer with at least 6 months of experience caring for an individual with a diagnosis of dementia. Between 12 November 2021 and 31 March 2023, 2332 carers were invited to take part in the study. 352 participants were randomised: 175 randomised to the iSupport intervention group and 177 to the usual care control group. The mean age of participants in the intervention and control groups was 63 and 62, respectively.

Main outcome measures

The CCA presented the disaggregated costs and health-related quality of life measured using the EuroQol five-dimension.

Results

There was no significant difference in generic health-related quality of life measured using the EQ-5D-5L (p=0.67). Both groups reported higher mean costs between baseline and 6 months, but the change in costs was significantly lower in the intervention group. Between baseline and 6 months, the mean change in total resource use costs from the public sector perspective was significantly different between groups (p=0.003, r=–0.161) reporting a mean change per participant of £146 (95% CI: –33 to 342) between the intervention and control groups. From the wider societal perspective, there was no significant difference (p=0.23) in the mean change in total resource use and informal care costs between the two groups from baseline to 6 months.

Conclusion

Use of iSupport was associated with reduced health and social care resource use costs for carers compared with care-as-usual. Self-guided e-health interventions for dementia carers may have the potential to reduce health and social care resource use and wider societal costs, but evidence relating to their effectiveness and cost-effectiveness is lacking.

Trial registration number

ISRCTN17420703.

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