Innovation in HF Care: A Pilot Study Using Simulation

Background Patient education is essential for impacting HF quality indicators, however is limited by typical passive, paper-based approaches. Simulation-based education, SBE (experiential, scenario-based learning) is highly effective in clinicians but underused in patients. We sought to: 1) determine feasibility of SBE in HF patients, 2) explore its effect on patient-reported outcomes (PRO); quality of life and self-care. Methods A prospective, pre-posttest, qualitative design studied a convenience sampling of consented patients admitted with HF to two urban hospitals. Within 2 weeks of discharge, SBE was performed in groups focusing on 3 scenarios: self-monitoring, HF medications, HF diet. SBE occurred in a home-like environment, in-center (IC) or through virtual telehealth (VT), allowing two-way, interactive video connection from home. Feasibility was determined by patient experience, events in SBE, and costs. Subjects completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) and Self-care Index for Heart Failure (SCHFI) questionnaires prior to discharge and 1 month after SBE, when evaluation of their experience occurred. Changes in KCCQ and SCHFI were analyzed. Results 51 patients were consented, age 63.95± 13.28 yrs, 64.7% male, HFrEF and HFpEF (53% vs. 47%, respectively), 40 completed SBE; 18 via IC and 22 through VT. 21 family caregivers were present. Patient experience themes were positive; who either agreed or strongly agreed the topics were relevant (n=38, 97.4%), increased their consistency following self-care (n=36, 92.4%), and were timely after discharge (n=33, 84.6%). They recommend this type of training to other HF patients (n=37, 94.9%). The average session duration was 146 +/- 21 minutes, average cost was $304 +/- $138 per participant. Issues identified with feasibility related to scheduling and technology, with no patient safety events. Observed 30-day readmissions were 7.5% with no 30-day mortality. Both KCCQ and SCHFI increased after SBE (n=39) with a significant magnitude of change shown by others to impact outcomes, figure. Improvements were consistent in both IC and VT simulation (IC p Conclusions This novel use of SBE methodology in person or by virtual telehealth was feasible, well received by HF patients and was effective to educate and engage them in their care. Additionally, it was associated with significant improvements in PROs that are known to impact HF quality metrics. Further validation in a broader HF population would help better determine its cost-effectiveness and impact on morbidity and mortality outcomes.