S. Brian Widmar PhD, RN, ACNP-BC Ann F. Minnick PhD, RN, FAAN Mary S. Dietrich PhD

1. Hospital Care Structure and Self-Care Education Processes of Ventricular Assist Device Programs: A National Study S. Brian Widmar PhD, RN, ACNP-BC Ann F. Minnick PhD, RN, FAAN Mary S. Dietrich PhD 2012 State of the Science Congress on Nursing Research

2. Acknowledgements • Use of the VU REDCap Survey service • Grant support: UL1 TR000445 from NCATS/NIH

3. Significance: Why VAD Self-Care Processes? • ↑prevalence and incidence of CHF • 2007: 5.2 million, 550,000 annually • 2011: 6 million; 670,000 annually • Increasing indications for VAD therapy • VAD has emerged as HF therapy • 2007: 208 patients 2011: 1,450 patients

4. Why Self-Care Processes • VAD care is complicated, continually demanding and intimidating to patients

5. Why Self-Care Processes • VAD is an exemplar of new technology requiring self-care processes – what is learned about VAD may help with other technologies. • Professional experience with different methods of VAD education

6. Gaps and Unknowns • How VAD patients learn self-care • How self-care education is provided; resource utilization • Extent to which type, method, and/or provider of self-care education influences outcomes

7. Aim • To describe care structures and self-care education processes used in VAD hospitals

8. Methods and Analyses • AIM: To describe care structures and self-care education processes used in VAD hospitals • Concepts: Definitions and measurement • Questionnaire development and testing • AHA Data • Human Subjects Protection

9. Administration • Sources of VAD Hospital Addresses • Inclusion criteria • 111 eligible • 3 cycles, 3 weeks apart • Paper or internet option

10. Methods • AIM: To describe care structures and self-care education processes used in VAD hospitals • Response rate: 64% • Generalizability tests

11. Results:Organizational Framework • More than half of VAD programs reported to > 2 departments • > 75% of VAD Coordinators reported to >2 administrators • Patient-to-Coordinator census • Median = 15; IQR (10, 20); range 2-40 pts/VC

12. Results: Healthcare Structure – Organizational Framework

13. Results: Health Care Structures – Caregiver Role Delineation

14. Results: Health Care Structures – VAD Coordinator Role Delineation

15. Self-Care Education Processes: LVAD Self-Care Validation (N = 71)

16. Self-Care Education Processes:% of Programs Using Only 1 LVAD Self-CareEvaluation Method (N = 71)

17. ResultsCapital Inputs

18. Self-Care Education Processes:Patient Support

19. Results: Cluster Analysis (N = 66)

20. Limitations • Additional VAD hospitals may exist but not likely • Lack of financial/budget information

21. Implications: Clinical • VAD programs should evaluate their existing care processes and supportive resources • Use > 1 method for validation • Use of simulation?

22. Implications: Future Research • Measurement of patient centered care satisfaction with SCE within VAD hospitals* • Explore relationship of patient satisfaction with patient service usage and health outcomes • Explore relationships of VAD program SCE elements and other patient outcomes • Mortality, quality of life, complications

23. Implications • Evaluate VAD coordinator preparation to teach • Evaluation of current staff RN and VAD Coordinator orientation programs • Are current methods of orientation and training adequate?

24. Next Steps • Describe reports of patient preference for • Methods used for self-care training • Methods used for evaluation of self-care • Exploration of patient and family/caregiver perceptions of difficulty of VAD care skills • Exploration of Staff RN and VAD Coordinator orientation programs

25. Next Steps • Apply a similar approach to the cardiac transplant patient population

26. Questions?