Document Type



Doctor of Philosophy (PhD)



First Advisor's Name

Jean Hannan, PhD, FAAN

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Dorothy Brooten, PhD, FAAN

Second Advisor's Committee Title

Committee Co-chair

Third Advisor's Name

JoAnne Youngblut, PhD, FAAN

Third Advisor's Committee Title

Committee Member

Fourth Advisor's Name

Timothy Page, PhD

Fourth Advisor's Committee Title

Committee Member


Heart failure, transitional care, patient perceptions, advanced practice nurse interventions, hospital readmission, posthospital discharge interventions, self-care, randomized controlled trial, telephone follow-up, heart failure costs

Date of Defense



Six and a half million Americans diagnosed with heart failure (HF) face dauntingly complex treatment regimens when transitioning from hospital to home care. Most are not prepared to perform their self-care. Advanced practice nurse (APN) interventions such as home visits as well as interventions that target perceived preparation for self-care have indicated improved health and costs outcomes. However, little is known about targeting perceived preparations for self-care with a low-cost APN intervention.

Purpose: This randomized controlled trial compared health outcomes, and healthcare charges between two groups of adults hospitalized with an HF diagnosis.

Methods: A control (n = 78) group received routine postdischarge care. An intervention group (n =76) received routine post discharge care plus follow-up telephone calls by APNs on posthospital discharge days 1, 7, 14, 21, 28, 42 and 56. Both groups were followed for the first 8 weeks posthospital discharge to examine health outcomes (i.e., perceived preparation for self-care, social support, problem-solving orientation), healthcare charges (i.e., emergency department visits, rehospitalizations) and charges for the APN follow-up (intervention group only).

Findings: At 8-weeks, comparing the intervention to the usual care group, the intervention group had significant differences in: perceived preparation for self-care mean scores (MI =67.37, SD = 16.6 vs. MC = 25.36, SD = 19, t(138) = -13.831, p=.000); hospital readmission rate (MI = 16.9% vs. Mc = 33.4%, χ2 = 4.59, p < .05); and mean healthcare charges (MI = $3,124, SD = $6,413 vs. MC = $6,897, SD = $11,268), t(142) = 2.45, p = .02)

Conclusion: Targeting a low-cost APN telephone follow-up intervention at subjective perceptions resulted in significantly higher levels of perceived preparation for self-care, lower rehospitalization rates and lower healthcare charges in the intervention group compared to the control group that did not receive APN interventions. These findings highlight the ability of APNs to apply low-cost, easy to apply follow-up interventions to vulnerable populations especially during times of major budget cuts that affect healthcare services.




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