Abstract 2508: Designing Disease Management Programs for Hispanics with Heart Failure
Hispanics are a growing population and heart failure (HF) is prevalent in this group. Disease management is effective in the general population, but little is known about how to design effective disease management programs for Hispanics with HF.
Purpose: The purpose was to identify the characteristics of Hispanic patients needing a relatively more intense disease management intervention.
Methods: Hospitalized Hispanics with chronic HF (N=134) were enrolled and randomized to intervention (n=69) or usual care (n=65) groups. Bilingual/ bicultural Mexican-American nurses provided 6-months of standardized telephone case management. Contacts with patients, family members, and others (e.g. physicians) were summed (mean 26.5 ±/− 11.8, interquartile range 19 –33.5 contacts) and used as the measure of intervention intensity. Multiple regression analysis was used to identify baseline characteristics of intervention group patients that identified those needing the highest intensity of care. Demographic (e.g., age, gender, education), clinical (e.g., depression, ejection fraction, comorbidity), and treatment characteristics (e.g., specialty of the primary provider) were entered into the analysis.
Results: The sample was elderly (72 ±/− 11 years), functionally compromised (NYHA III/IV, 81.3%), poorly educated (78.4% <high school), and economically disadvantaged (81% living in poverty). Many (55%) were unacculturated into U.S. society. A model of six variables explained 32% of the variance in intervention intensity (F=3.4, df 6,44, p<.01). Intervention group patients needing the highest intensity were those who were poorly educated, younger in age, more depressed, lower in quality of life, lower in ejection fraction, and not cared for by a cardiologist. Culturally specific issues such as level of acculturation into U.S. society and barriers to care were not significant predictors of intervention intensity.
Conclusion: The intensity of disease management can be customized based on the characteristics of the population to be served. These results suggest that, in U.S. Hispanics with HF, six easily measured characteristics can be used to make decisions about allocating resources to the program.