Keywords: Congestive Heart Failure, Teach-Back, Readmission, Education.

 

The researchers noted a significant variance in 180-day quality of life between the intervention and control group (Ong et al. (2016). Similarly, Almkuist (2017) conducted a systematic review to analyze recorded evidence on the application of Teach-Back in-patient education to prevent 30-day readmission among patients with CHF. Almkuist findings were similar to those of Ong et al., which outlined that Teach-Back methods reduce the rate of readmission when combined with another initiative such as telemonitoring. Additionally, 

Almkuist (2017) analyzed additional outcomes of Teach-Back method other than readmission. The findings indicated that the Teach-Back methods have a positive effect on health outcomes, self-care, and health literacy.  

 
Additionally, Dinh et al. (2016) stated that Teach-Back methods were introduced as a way of promoting health literacy among patients. However, evidence supporting the efficacy of health education imparted through teach-back strategies has not been systematically reviewed. The researchers conducted a systematic review to analyze evidence on the application of Teach-Back methods in health education programs for improving adherence to recommended outpatients services and self-management among patients with chronic diseases. Randomized, non-randomized, and cohort case-control studies discussing the application of Teach-Back on adults of ages 18 and above with one or more chronic illness were systematically reviewed. The outcomes measured by the researchers were self-management, compliance with recommendations, disease-specific knowledge, quality of life, readmission rate, and knowledge retention. Dinh et al. (2016) findings were similar to that of Ong et al. (2016) that predominantly, Teach-Back methods have positive effects in various healthcare outcomes such as adherence rate and disease-specific knowledge. The intervention group had a P value of 0.06 when compared to the control group.  However, in some outcomes such as readmission rate and hospitalization, the reduction was not consistently significant (Dinh et al., 2016; Ong et al. 2016). 

According to Dastoom, Elahi, Baraz, & Latifi (2016) published guidelines stipulate that education is an essential intervention in readmission prevention. However, the most effective method of educating hospitalized patients suffering from myocardial infarction about self-care is unknown. The researchers conducted RCTs in two academic healthcare systems on one hundred HF patients aged 50 and above. The participants in the intervention group were educated and evaluated using Teach-Back method. Dastoom et al. (2016) findings were similar to that of Dinh et al. and Ong et al. that the teach-back method increased the patients’ knowledge of self-care. The outcomes that 75% of the patients answered the Teach-Back questions correctly (P < .001) was significantly associated with the time spent teaching in the intervention group. 

However, Dastoom et al. and Dinh et al. differed on the significance of the effect of Teach-Back on readmission rate. Dastoom et al. findings indicated that Teach-Back methods significantly reduced readmission rates by 56.2% and a P value of 0.004, while Dinh et al. concluded that the reduction in re-hospitalization was insignificant.

Wyer et al. 2016 conducted a case study, which associated multidisciplinary training in evidence-based practice (EBP) with reduction of 30-day readmission among patients with CHF hospitalized in a community teaching hospital. HCPs attended a three-day innovative capacity building conference in evidence-based healthcare in three years. The facilitators applied a knowledge-to-action model in training the interdisciplinary healthcare team. 

The researchers concluded that the knowledge transition model resulted in the implementation of an efficient budget program that decreased readmission of patients with HF. Similarly, a systematic and meta-analysis conducted by Leppin et al. indicated that 30-day readmission rate could be decreased through tested interventions such as teach-back strategies. However, Long, Babbitt, & Cohn, (2017) conducted a systematic review to analyze the effect of home telemonitoring on patients with CHF on 30-day re-hospitalization which contrasted with Wyer et al. and Leppin et al.  

Long et al. analyzed six articles with a sample size of 51,014 participants. Each study was appraised to determine the level of evidence using the American Association of Critical Care Nurses (AACN) grading system. The researchers could not give recommendations for practice because of the limited evidence. Long et al. (2016) recommend that future research should be performed to facilitate comprehension of home telemonitoring and how the intervention effectively reduces 30-day readmission for patients suffering from CHF. 

Burke, Guo, Prochazka, & Misky, (2014) conducted a research to assess the effectiveness of various interventions in reducing readmission. Through the electronic database search 4045, studies were identified, among which 3979 were excluded. The researchers analyzed 66 studies, which had met the inclusion criteria to analyze the efficacy of patient education and care coordination in the reduction of re-hospitalization. The researchers’ analyzed re-hospitalization using Chi-Square tests and concluded that increasing the number of targeted domains within the ideal transition of care (ITC) could result in a reduction of 30-day readmission. 

The findings by Burke et al. that the integration of education, monitoring, and managing symptoms after discharge effectively reduced readmission were similar to those of Ong et al. The differences in the studies were that Ong et al. analyzed telemonitoring is assessing the patients, while Burke et al. examined physical follow-ups.  

Drisoll et al. (2016) conducted a systematic review with the purpose of examining the systems of care for CHF that facilitate the reduction of re-hospitalization and mortality. The researchers analyzed electronic databases for RCTs, non-randomized trials, and cohort studies based on the PRISMA statement. Three reviewers independently assessed the eligibility of the studies using Newcastle-Ottawa and GRADE rating tools for non-randomized and RCTs respectively to eliminate selection bias. Five hundred and twenty studies were identified, however after removing the duplicates and analyzing the title and abstract, 491 studies were excluded. The researchers selected 29 articles on workforce system of care, primary care, telemonitoring, and transitional care. The research findings indicated that proficient CHF team, quality improvement programs, and nurse-led clinics improved the quality of care and reduced hospital mortality and readmission. However, similar to Long et al. (2016), Drisoll et al. (2016) could not give a conclusive finding on the efficacy of telemonitoring in reducing the readmission of patients with CHF because many studies outlined conflicting evidence. 

Noori et al. (2014) conducted a cohort study to analyze the effect of multiple indicators of social-economic status (SES) on CHF related readmission. The researchers involved 315 patients with no history of hospitalization because of CHF. The principal component analysis (PCA) was applied to facilitate the subdivision of patients into quarters regarding SES. The stratified Cox regression analysis was used in calculating the Hazard Ratios (HRs). Noori et al. concluded that 40% of patients with CHF are readmitted to healthcare facilities. Additionally, patients with earnings ranging from $176–$352 had a higher probability of being re-hospitalized in comparison to individuals with an income of $752 or higher and as indicated by 2.66 (95% Cl=1.51-4.66). Similarly, 

Mangla et al. (2018) outlined the socioeconomically disadvantaged patients are at an increased peril of adverse CHF outcomes because of non-adherence to medication and follow-up recommendations. The study recruited 72 physicians and their 320 patients within two years. The CHF patients were randomized into two groups of 157 and 163 participants in the intervention and control group respectively. The researchers assessed the impact of weekly home visits from community health workers and monthly HF management through educational tip sheets in reducing 30-day readmission among patients with an annual income of $30,000. The researchers applied Congestive Heart Failure Adherence Redesign Trial (CHART) to analyze the outcomes of the interventions and concluded that home visits and education decreased non-compliance, which resulted in reduced readmission rates (Mangla et al., 2018). 

 Descriptive research design identifies a current problem. A hypothesis is formed after the data is collected. The data could be obtained from either primary or secondary sources (Center for Innovation in Research and Teaching [CIRT], 2018). 

Measurement: The Measurement of a study focuses on:

(LoBiondo-Wood & Haber, 2014).

Date Analysis:
Independent Variables and dependent variables are identified in the study

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Dastoom, M., Elahi, N., Baraz, S., & Latifi, S. M. (2016). The Effects of Group Education with the Teach-Back Method on Hospital Readmission Rates of Heart Failure Patients. Jundishapur journal of chronic disease Care, 5(1). doi: 10.17795/jjcdc-30377.

Dinh, T. T. H., Bonner, A., Clark, R., Ramsbotham, J., & Hines, S. (2016). The effectiveness of the teach‐back method on adherence and self‐management in health education for people with chronic disease: a systematic review. JBI database of systematic reviews and implementation reports, 14(1), 210-247. doi: 10.11124/jbisrir-2016-2296

Driscoll, A., Meagher, S., Kennedy, R., Hay, M., Banerji, J., Campbell, D., ... & Nadurata, V. (2016). What is the impact of systems of care for heart failure on patients diagnosed with heart failure: A systematic review. BMC cardiovascular disorders, 16(1), 195. doi: 10.1186/s12872-016-0371-7

Center for Innovation in Research and Teaching (2018). Quantitative approaches. Retrieved from https://cirt.gcu.edu/research/developmentresources/research_ready/quantresearch/approaches

Gheorghiu, V., & Barkley, T. W. (2017). Identification and prevention of secondary heart failure: A case study. Critical care nurse, 37(4), 29-35. https://doi.org/10.4037/ccn2017478

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Long, G., Babbitt, A., & Cohn, T. (2017). Impact of home telemonitoring on 30-day hospital readmission rates for patients with heart failure: A systematic review. Medsurg nursing, 26(5), 337-348. Retrieved from http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?vid=1&sid=3937df68-871f-4de5-aa19-862229b22e18%40sessionmgr4009

LoBiondo-Wood, G. & Haber, J (2014). Nursing research: Methods and critical appraisal for evidence-based practice. St. Louis, MO. Elsevier.

Mangla, A., Doukky, R., Richardson, D., Avery, E. F., Dawar, R., Calvin, J. E., & Powell, L. H. (2018). Design of a bilevel clinical trial targeting adherence in heart failure patients and their providers: The Congestive Heart Failure Adherence Redesign Trial (CHART). American heart journal, 195, 139-150. https://doi.org/10.1016/j.ahj.2017.09.016

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Noori, A., Shokoohi, M., Baneshi, M. R., Naderi, N., Bakhshandeh, H., & Haghdoost, A. A. (2014). Impact of socio-economic status on the hospital readmission of Congestive Heart Failure patients: A prospective cohort study. International journal of health policy and management, 3(5), 251.doi:10.15171/ijhpm.2014.94

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Wyer, P., Stojanovic, Z., Shaffer, J. A., Placencia, M., Klink, K., Fosina, M. J., ... & Graham, I. D. (2016). Combining training in knowledge translation with quality improvement reduced 30‐day heart failure readmissions in a community hospital: a case study. Journal of evaluation in clinical practice, 22(2), 171-179. doi:10.1111/jep.12450

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