Abstract

Heart failure is the most common cause of hospitalization in Canada. Over half of the hospitalized patients are readmitted within 6 months of discharge. These patients face even greater health risks as a result of gaps in care which occur during transition of care from hospital to community. The research presented in this dissertation builds on the existing body of research on transition of care by identifying issues that patients face after discharge from hospital and by proposing and evaluating a remote self-care education program.

In the first part of this thesis, methodologies relevant to development and evaluation of information systems for healthcare are considered, and an alternative framework is proposed.

Consistent with the proposed framework, patient self-management education, the educational approach which forms the basis of the proposed intervention, is validated through a systematic review of literature. Next, two qualitative studies were conducted in order to identify issues that occur during transition of care, from the perspectives of healthcare practitioners and patients. The first study consisted of a contextual inquiry and interviews with case managers. In the second qualitative study, patients with heart failure who were discharged to the community were interviewed and barriers and enablers to care that affect this patient population were identified. Based on the feedback from the systematic review and the qualitative studies, an intervention consisting of remote self-management education was designed. In a randomized study involving patients with heart failure released from hospitals in the Greater Toronto Area, two methods of delivery of self-care education were compared. One group was given an access to a web-site containing educational content, and another group was also participating in four live telephone-based education sessions led by a cardiac nurse. Results demonstrated that patients in the live education groups scored higher on the self-care knowledge test following the intervention. This dissertation concludes with a distinction of the implications of this research for future care of congestive heart failure patients.