Transcript Ginevic_PosterPresentation

Role of culturally tailored nutrition education on improving CHF patient’s knowledge and preventing
heart failure readmissions in BLHC
Dietetic Intern: Ilona Ginevic
Mentor: Karen Formato MS, RD, CDN
BACKGROUND
Congestive heart failure is the number one cause of
hospitalization for Medicare patients (1,3). The
national U.S. hospitalization rate was 19.6 per 1000
in women over age 64 and 22.9 per 1000 men over
age 64 (3). Additionally, approximately 25% of CHF
patients are typically readmitted to the hospital
within 30 days after discharge(4). It is the most
common cause of hospital readmissions and
accounts for 34% of cardiovascular-related deaths.
The 30-day readmission rate of CHF patients at
Bronx Lebanon Hospital Center (BHLC) is 29.6% and
it is 4.6% higher than the U.S. national readmission
rate (5). Higher admission rates at BLHC may be
related to Bronx demographics, since the majority
of the Bronx residents are Hispanics (48.4%) and
Blacks (31.2%) (6). Considering this, there is a huge
need to address the cultural component in
educating this particular patient population.
Managing CHF is quite complex. Patients have to
take multiple medications, follow a low salt diet,
weigh themselves daily, and restrict the amount of
fluid intake (10,11).
Many other factors can contribute to CHF
readmissions, including the lack of patient
compliance and education regarding their diet and
condition, poor communication between medical
staff and patient, and very little cultural sensitivity
while addressing the patient’s needs.
There is a great need to lower the significant
volume of CHF readmissions. This will also lead to
reduced costs and improve the quality of patient
care. Registered dietitians should therefore
implement initiatives targeting the reduction of
readmission rates for congestive heart failure
patients.
The purpose of this research project is to
determine if adding nutritional component, focused
on cultural aspect of the therapeutic diet, will
improve knowledge, compliance to the diet and
thereby lead to a reduction in readmission rates of
CHF patients to the BLHC.
Research question: Is there a reduction in
readmission of patients with CHF when culturally
sensitive diet education is provided during initial
admission?
RESEARCH POSTER PRESENTATION DESIGN © 2012
www.PosterPresentations.com
RESULTS
METHODOLOGY
All patients who were admitted or readmitted to
BLHC with the diagnosis of CHF were identified by
cardiology doctors and invited to attend an
educational session about the role of a therapeutic
diet in managing their condition. At this session,
two PowerPoint presentations were given. For the
first presentation, pharmacy residents discussed
etiology, symptoms, and medications used in the
treatment of the condition. The next presentation
covered the nutritional needs required to
effectively manage CHF. A Spanish speaking visiting
nurse was available throughout the educational
session and translated the information for the
Spanish-speaking
patients.
Two
standardized
questionnaires were then handed out in order to
determine whether or not the patient has the ample
knowledge, and the willingness, to comply with the
diet. One questionnaire was handed out before the
educational session, and the second 2 hours after
the session. This helped in assessing patient’s
retention of the information and determined what
areas need to be retaught. All questionnaires were
available in English and Spanish.
Patient’s medical record was used to assess if these
patients were readmitted at BLHC for heart failure
within 30 days following this intervention.
Design of the study:
Single-group, Evaluation pre- and post- test design
Statistical Analysis:
Descriptive statistics utilizing EXCEL were used to
characterize the study population. A percentage
method was used to calculate and depict the
differences in total compliance and understanding
of the self-care before and after education.
Inclusion Criteria:
Every patient admitted with CHF or newly
diagnosed with CHF.
Exclusion Criteria:
Refusal to participate in inpatient education.
Patients with dementia or altered mental status
Time frame: 6 weeks
Funding; There was no funding available for this
intervention
CONCLUSIONS
The primary outcome of the study was to increase
the level of patients’ nutritional knowledge. Prior to
the education session only 21% of the participants
knew how to read food labels in order to determine
the desirable amount of sodium per serving they
should be looking for in order to maintain their salt
intake within the healthy range. The knowledge of
the participants significantly increased, resulting in
87% of them successfully determining the
recommended amount of sodium per serving. Also,
out of 38 participants, none was able to recognize
recommended daily intake of sodium prior to the
educational intervention, however, 47% of the
participants knew the correct answer after
attending the class. The data is presented in the
graph below.
Graph1. The assessment of CHF patients’ knowledge
prior and post- education
100%
80%
60%
Pre-educational
40%
Post-educational (n-30)
20%
0%
Q1
Q2
Q3
Q4
Q5
Q1. Select foods which are high in salt
Q2. While looking at the sodium content on the food label, which
product would be desirable choice for you condition (CHF)?
Q3. What is your sodium allowance per day?
Q4. What is the maximum amount of fluid you are allowed to drink?
Q5. What is maximum acceptable weigh gain per week?
Following current educational intervention the
readmission rate fall from 29.6% to 18%.
Readmission rates among CHF patients
29.6%
18%
control
intervention
Patients who attended educational session are less
likely to be readmitted with the exacerbation CHF.
• Prior to the education session, CHF patients tend
to have low levels of knowledge about CHF and
lacked an understanding about the affect of a
diet on their condition.
• Improved nutrition related knowledge leads to
reduced CHF readmission rates
• Patients respond well when cultural aspect is
considered
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