Date of Award

2014

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Kathryn H. Bowles

Abstract

Heart failure (HF) is the leading cause of rehospitalization in the United State. One potential way to reduce HF rehospitalizations is through the use of telehomecare, which is a remote monitoring intervention in home care settings. However, studies on telehomecare use conducted in the United States have demonstrated mixed results in reducing HF rehospitalizations. Little is known about risk factors for rehospitalization during a telehomecare episode. The aims of the study were to identify patient characteristics associated with all-cause rehospitalizations and patient characteristics associated with time-to-first rehospitalization within 60 days of the home health care episode. This is a non-experimental, cross-sectional secondary analysis of the Outcome Assessment Information Set dataset from Medicare recipients with HF provided with telehomecare. This study used multiple logistic regression, decision tree techniques and survival analysis methods. The main findings of this study were that results of a formal pain assessment and the ability to dress one's lower body safely were associated with rehospitalizations. In particular, subjects who were independent in dressing their lower body had a consistently higher risk of rehospitalization than functionally dependent groups. While the logistic regression model and survival analysis presented the associations between rehospitalization and single risk factors, the decision tree techniques presented the relative contributions of and interactions between risk factors for rehospitalization as a global picture, which may provide clinicians with a visual guide to targeting those patients most likely to benefit from telehomecare, or who may need additional interventions.

Included in

Nursing Commons

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