Background
Congestive heart failure, also known as CHF, is increasingly becoming a major health problem in the United States. According to Thomsen, Nicolaisen, Hasvold, and Sorensen (2017), CHF is a condition where the heart fails to pump enough blood to all body cells, making the nutrients and oxygen insufficient in the body. The condition is common among the elderly, but it can also affect the younger generation. In a report by Yu et al. (2015), about 5.7 million adult Americans suffer from this condition. The number can be higher than the current estimates because some of them are not diagnosed early enough. The report also shows that one in every nine deaths in the United States is believed to be caused by heart failure.
Once one is diagnosed of congestive heart failure, he or she has to be subjected to a series of medications to ensure that the condition is stabled. Even with the advanced medical facilities and highly trained staff in the country, about half of those diagnosed with the disease die within 5 years. Bartunek et al. (2015) observe that congestive heart failure is one of the most expensive diseases to manage. It costs the government, individual families, and employers a lot. To the government, there is increased pressure to expand the healthcare facilities and hire more nurses to help in meeting the increased demand. To individual families, they have to spend their resources to ensure that they can offer their loved one the best care possible. To the employer, there is the loss of time that would have been used to further the goals of the company.
Purpose and Major Goals
The United States’ government is spending a lot of resources in the healthcare sector because of the increasing number of people who are hospitalized for various reasons. Congestive heart failure is one of the diseases that are becoming common in the country. It is more common among the elderly, especially those with significantly reduced physical exercise. The main concern is that cases of hospital readmissions are becoming more frequent. It is expected that once one is given proper medication, he or she would lead a healthy life thereafter. However, sometimes that is not the case. The more these patients are readmitted, the more pressure they put on the healthcare facilities. It is important to improve quality of care offered to CHF patients to ensure that cases of readmissions are eliminated. It is also necessary to empower patients so that they can lead healthy lifestyles that would limit development of CHF. This paper focuses on how cases of hospital readmissions of patients with CHF can be eliminated to help ease the financial burden associated with the disease.
Hypothesis
According to Covell (2016), evidence-based management therapies can help in improving the quality of services offered by healthcare professionals. It enables them to use tested strategies that improve the superiority of the services they offer. The following hypothesis was developed based on that fact:
H1. Healthcare professionals can implement existing evidence-based management therapies and develop superior strategies to prevent hospital readmission for elderly patients with congestive heart failure (CHF).
Variables
It is believed that with improved healthcare delivery that focuses on evidence-based management therapies, cases of hospital readmissions can be reduced significantly. On the other hand, advanced age increases chances of one developing congestive heart failure problem. In this paper, the dependent variable is the number of hospital readmissions within a specified period. The independent variables are the known forces that influence such readmissions such as age of the patient, management practices, and intervention strategies used.
Research questions
It is important to develop research questions that would help in collecting primary data from the field. It is important to determine if the identified independent variables above have any impact on the dependent variable of this study. The following are the research questions that were developed:
- What interventions are currently being used to reduce re-hospitalization for persons with congestive heart failure (CHF)?
- What gaps affect the applicability and effectiveness of existing interventions?
- What evidence-based therapies can be adopted to manage CHF in elderly patients?
- What should future healthcare researchers do to prevent readmissions for persons with CHF?
- What is the role of top management in healthcare organizations in dealing with the increasing rate of readmission for CHF patients?
The researcher collected and analyzed primary data to respond to the above questions. It is important to note that information obtained from books and journal articles, through literature review, also informed the conclusion that was made in this research.
Literature Review
Congestive heart failure is a problem that has been a major concern in the American society for a long time. According to De and Omland (2018), one of the main problems that cause this problem is the kind of lifestyle that most Americans lead. The United States has some of the most advanced infrastructure, and the living standards are relatively one of the highest. From an early age, many people learn to use machines to do most of the manual tasks. Washing machines has made the process of washing clothes less manual. People prefer using cars and public service vehicles when going to work or school other than walking.
Electronic systems have made it easy for people to get entertained at home instead of having to go to the cinemas that were very popular in the past. Social networks such as Facebook, Twitter, YouTube and Instagram have made it easy for people to interact and engage with friends instead of having to make physical visits. Bartunek et al. (2015) defines this scenario as a technology era where people let machines and systems do the manual jobs as they relax without having to engage in numerous physical exercises. The problem with this new lifestyle is that the body is denied the physical energy that it needs to function normally. Almost all the time, the body and the heart is in a relaxed state.
Understanding Heart Failure
According to Marcus, Rio, Schultz, Xia, and Schultz (2014), heart failure occurs when blood (oxygen and nutrients) is not sufficiently pumped into the rest of the body because of the weakness of the heart. It is important to note that when the condition occurs, the heart will continue beating. However, the force that it generates is not strong enough to force blood into all body organs and cells. Three different types of heart failure exist. The first one is left heart failure. It occurs when the muscles of the left ventricle are not strong enough to pump blood into the rest of the body and the fluids from the body cells back up (Azad & Lemay, 2014). What that happens, the fluids leak into the lungs, which causes shortness of breath in the affected victim. The second type is right heart failure. It occurs when the muscles of the right ventricle is not strong enough to pump adequate blood into the lungs (Levine, 2016). It causes a situation where blood flows back, and may cause fluid to leak into organs and tissues. In most of the cases, right heart failure is often caused by left heart failure.
When the left ventricle is unable to supply enough blood to body cells, the cells in the right ventricle will be affected. It means that in case left heart failure is not managed within the right time, it may easily lead to right heart failure. The third type is biventricular heart failure (Andreadis, 2016). As explained, in case the left heart failure is not controlled in time, it may lead to a situation where both parts of the heart are not functioning. Such conditions must always be treated as emergency because the ripple effect that it may have on the body can be devastating. The risk of developing biventricular heart failure is more common among the elderly than it is among the middle-aged adults and young children. Their (the elderly) reduced physical activity puts them at a higher risk of acquiring this problem compared to the younger generations. However, De and Omland (2018) warns that that does not mean the youth and young adults are out of risk of developing congestive heart failure.
Current Strategies Used in Managing Heart Failure
It is important to understand the pharmacotherapy in congestive heart failure. De and Omland (2018) note that most of the existing randomized controlled clinical trials have not adequately focused on older CHF patients. However, current studies have tried to address this challenge by explaining how this problem can be addressed specifically among adults. Levine (2016) observes that currently, most of the cases of CHF are managed through medication. Diuretics are common medications that are often used when managing CHF patients. Katritsis (2016) observes that sometimes it may be necessary to administer digixin or beta-blockers. Other common management practices include angiotensin receptor blocker (ARB) therapy and Spironolactone (Azad & Lemay, 2014). In some extreme cases, it becomes necessary to conduct a surgical process to clear the blockage. Thiriet (2015) state that one of the biggest concerns among medical scholars and practitioners is that currently there are no specific standards and practices that must be followed when managing the problem. Every physician has the liberty to choose the approach that he or she considers appropriate.
Using Evidence-Based Therapies in Managing Heart Failure
According to Andreadis (2016), it is important to have a standard practice when managing congestive heart failure. The current approach that allows individual doctors to embrace different methods based on their personal decisions is not appropriate in the modern society where advanced technology has enhanced the process of health delivery. Multidisciplinary action plans (MAP), also known as clinical care maps or critical pathways are some of the evidence-based therapies which are increasingly becoming popular in managing congestive heart failure (Andreadis, 2016). Developed by a panel of physicians to guide inpatient management of CHF, MAP a structured nursing plan for inpatients. It recommended that before a CHF patient is discharged from hospital, a family practitioner, cardiologist, internist, nephrologists, critical care nurses, and a representative of the hospital should be present and give their approval. The goal is to ensure that when the patient is leaving the hospital, the entire medical team will be certain that all the necessary factors are taken into consideration to minimize chances of hospital readmissions.
Research Methods
Type of Research
In this study, the researcher chose meta-analysis as the most appropriate research design. It is a way of combining data obtained from different sources. The main advantage of this method is that it makes it possible to use both primary and secondary data sources. Secondary data was obtained from books, journal articles, and reliable online sources. Primary data was obtained from a sample of respondents who accepted to be part of this study. Although it can be time consuming, this method makes it possible to collect comprehensive data from various sources. In the process, it enhances the reliability and validity of the study.
Data Collection Methods
Data used in this study was collected from two different sources, primary and secondary data. Secondary data sources were obtained from journal articles, books, and reliable online sources. They formed the basis of this study as they provided the basic information needed before collecting data from primary sources. Primary data was obtained from a sample of respondents. The researcher sampled respondents from a local hospital. The sample included nurses, doctors, and clinical officers who have had opportunity to handle CHF patients. The sample also included CHF patients. A face-to-face interview was conducted to obtain primary data from these respondents.
Data Analysis Tools
The primary data collected from the respondents had to be analyzed to confirm the hypothesis that was set in chapter 1. A statistical data analysis was conducted to determine if the findings from the primary data confirms the hypothesis. A regression analysis was used in analyzing primary data.
Research Sample
A sample of respondents who were engaged to help in collecting primary data included patients and a team of medical practitioners. Male and female CHF patients aged between 25 and 55 were involved in this study. The research sample also included nurses, doctors, and other specialists who have handled CHF patients. The researcher will first contact the administration to seek for permission to conduct this study at the institution. The sampled participants will be contacted through phone calls.
Target Audience
This study targets healthcare professionals who are working in various facilities that handle CHF patients. Some of these specialists include family practitioners, cardiologists, internists, nephrologists, critical care nurses, and hospital managements. The goal is to ensure that they are offered information that will enable them embrace evidence-based practice when offering care to CHF patients. The goal is to ensure that cases of hospital readmissions of CHF patients are reduced as much as possible.
Reliability and Validity
The study is expected to provide reliable information that can be used by medical practitioners to improve the service they offer to their patients in healthcare settings. As such, issues of reliability and validity had to be taken seriously. Validity of data was enhanced by ensuring that data is obtained from different sources (primary and secondary data). To enhance reliability of data, the researcher avoided personal bias when collecting both primary and secondary data.
Limitations
It is important to identify major limitations that were encountered in this study. One of the main challenges was the inability of some of the respondents to take part in this study. The researcher was able to replace such participants to ensure that the expected number of participants was involved in the study. It was desirable to collect data from various hospitals across the country. However, time was a major limitation. The researcher was forced to collect data from a specific hospital because of the limited time.
Feasibility
The researcher ensured that the findings and the proposals made in this study were as practical as possible. This was important because of the need to make the project easy to implement. Information obtained from various sources was presented in a clear manner for ease of understanding in case one may consider it appropriate to implement the new policies in a hospital setting.
Analysis and Results
After collecting primary data from the respondents, the next important step was to analyze it to come up with specific findings. It was necessary to determine if data collected from both primary and secondary sources supported the hypothesis that was set in chapter one of this paper. The following was the first question that was posed to the respondents:
What interventions are currently being used to reduce re-hospitalization for persons with congestive heart failure (CHF)?
The respondents were asked to identify the current interventions in use to help in reducing cases of readmission of CHF patients. According to the participants, some of the treatment methods for CHF commonly used includes angiotensin-converting enzyme inhibitors (ACE inhibitors), beta-blockers, and diuretics. When the condition is worse, a surgical process may be necessary. They were also asked to state whether they believe that these current methods are effective in managing this problem. The following figure shows their response.
It is evident from the figure above that majority of the respondents feel that the current intervention strategies are not effective enough in reducing hospital readmissions. It is a sign that better strategies are needed to help in managing this problem. The question below focused on determining the gaps that affect the applicability and effectiveness of the existing interventions.
What gaps affect the applicability and effectiveness of existing interventions?
The researcher asked the respondents to state the known gaps in the existing interventions. Most of the respondents stated that lack of uniformity in managing CHF patients. They stated that the current methods make it impossible to predict how a patient will be handled. The respondents also noted that a clear guideline that defines how different specialists should be coordinated in offering quality care to the patients is lacking.
What evidence-based therapies can be adopted to manage CHF in elderly patients?
The respondents were in unanimous agreement that evidence-based therapies can help in managing CHF among the elderly patients. The response obtained from them was statistically analyzed and the figure below shows their response.
Multidisciplinary action plans (MAP) was identified by the participants as one of the evidence-based approaches of managing CHF patients.
What should future healthcare researchers do to prevent readmissions for persons with CHF?
Most of the respondents stated that future healthcare researchers should focus more on how interdisciplinary approach to managing CHF patients can be promoted in hospitals. They strongly support the need to ensure that different specialists work in close coordination to ensure that patients are offered quality care.
What is the role of top management in healthcare organizations in dealing with the increasing rate of readmission for CHF patients?
The management has an important role to play in managing the increasing rate of hospital readmissions for CHF patients. The respondents stated that the top managers have a role in ensuring that their institutions are adequately staffed and equipped with the necessary equipment. The respondents also stated that top managers should create an enabling environment where specialists can closely coordinate to ensure that excellent service is offered to these patients.
Discussion of hypothesis
Congestive heart failure is increasingly becoming a major health problem in the United States. Medical practitioners have blamed reduced physical activity and poor eating habits as the leading causes of this health problem. According to De and Omland (2018), one of the most common outcomes of limited physical activity is the development of cholesterols in the body. The blood vessels may be blocked or narrowed as the cholesterol continues to accumulate. Covell (2016) observes that when one is physically active, the body generates enough heat that reduces accumulation of body fat in the vessels. Sometimes excess fat is converted into energy during such physical exercises. Another common outcome of reduced physical activity is the weakening of the body muscles. According to Lamarck’s Use and Disuse Theory, when body organs are not regularly used, they tend to become vestigial. The same case happens with the heart muscles.
When the body is put through regular physical exercise, the heart muscles are forced to pump more blood to various body cells and they also get strengthened in the process. The more one strengthens the body muscles through regular physical exercise, the more the heart muscles get stronger. The opposite is true when one avoids physical exercise. In the current society where people prefer spending most of their times on their Smartphone or behind television screens, it becomes common for the heart muscles to grow weak. The situation is worsened by the poor diet that is full of calories and other less healthy nutrients (Andreadis, 2016).
It explains the reason why congestive heart failure is becoming common, especially among the retired Americans who believe in spending most of their time relaxing. The findings from the primary data analysis should that evidence-based therapies are critical in enhancing quality care when handling CHF patients. It makes it easy for different medical specialists to work closely together to enhance quality of care. It also requires the management to be actively involved in ensuring that hospitals are adequately staffed and with the required equipment that makes it easy to deliver superior service. These strategies may help reduce cases of hospital readmission of CHF patients. The findings confirm the research hypothesis.
Conclusion
Congestive heart failure is currently one of the leading problems in the healthcare sector. The government is spending billions to equip hospitals and hire adequate staff to handle CHF patients. Cases of hospital readmissions of these patients is a major concern because of the costs involved and the pressure it puts on the healthcare facilities. The findings of this study show that evidence-based therapies are critical in increasing quality of care to help reduce such readmissions. The hypothesis of this research was approved. Implications of this study strongly suggest that further studies are necessary to determine how evidence-based therapies can help reduce cases of readmissions.
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