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. 2012 May;33(9):1112-9.
doi: 10.1093/eurheartj/ehr306. Epub 2011 Sep 15.

Effects of person-centred care in patients with chronic heart failure: the PCC-HF study

Inger Ekman  1 , Axel Wolf, Lars-Eric Olsson, Charles Taft, Kerstin Dudas, Maria Schaufelberger, Karl Swedberg
Affiliations

Effects of person-centred care in patients with chronic heart failure: the PCC-HF study

Inger Ekman et al. Eur Heart J. 2012 May.

Abstract

Aims: Person-centred care (PCC) emphasizes a partnership in care between patients and healthcare professionals and is advocated by WHO as a key component of quality health care. We evaluated outcomes of PCC in hospitalized patients with chronic heart failure (CHF) with respect to the length of hospital stay (LOS), activities of daily living (ADL), health-related quality of life (HRQL) and 6-month readmission rate.

Methods and results: During 2008-2010, 248 consecutive patients hospitalized for symptoms of worsening CHF were enrolled in a controlled before and after designed study. A Usual care group (n= 123) was recruited according to pre-defined criteria to map usual CHF care and assess outcomes at five designated hospital wards. Based on the mapping, a panel of in-house clinicians and researchers developed measures aimed at aligning usual care with basic PCC principles. These measures were incorporated into a study protocol to guide care procedures at the same five wards. Person-centred care was then implemented at these wards and evaluated in 125 patients. Both length of hospital stay and 6-month readmission were extracted from patient records. Activities of daily living were evaluated at baseline and discharge and HRQL was evaluated at baseline and after 3 months. In the analysis of all patients, the LOS was reduced by 1 day (P = 0.16) while retaining ADL (P = 0.07). When PCC was fully implemented (per protocol analysis), LOS was reduced by 2.5 days (P = 0.01) and the ADL-level better preserved (P = 0.04). Health-related quality of life and time-to-first readmission did not differ.

Conclusion: In this proof-of-concept study, our findings suggest that a fully implemented PCC approach shortens hospital stay and maintains functional performance in patients hospitalized for worsening CHF, without increasing risk for readmission or jeopardizing patients' HRQL.

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Figures

Figure 1
Figure 1
Study design, data-collection illustrated by white boxes. The Usual care group was used to map the care and formed the basis for the intervention with person-centred care as developed by the expert team (physicians, nurses, physiotherapists, and patients).
Figure 2
Figure 2
Study profile.
Figure 3
Figure 3
Length of stay: the Usual care group vs. the PCC group for both analysis of all patients and per-protocol analysis. The analysis of all patients was adjusted for New York Heart Association (NYHA) class, dyspnoea (five-grade Likert scale), and age using logistic regression. The PP analysis was adjusted for NYHA class.
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