Date on Master's Thesis/Doctoral Dissertation

12-2011

Document Type

Master's Thesis

Degree Name

M.S.

Department

Bioinformatics and Biostatistics

Committee Chair

Myers, John Allen

Subject

Heart--Diseases--Patients--Rehabilitation; Congestive heart failure--Treatment

Abstract

Background: CHF is a chronic disease that affects nearly five million people each year; in which at least 500,000 are newly diagnosed cases. Patients diagnosed with this disease will be under a physician's care for the remainder of their life. It is of great importance that the strategy, used to manage these patients, maximizes their health outcomes in a cost effective manner. Objective: The objective of the current analysis is to compare the health outcomes with the available CHF management methods: the 'Case Management' (CM), the 'Self Management' (SM) and the current 'Standard of Care' (SC). Also, this study aims to identify the optimal management programs for CHF patients. Data: Data used are from a multicenter clinical trial funded by the AHRQ. The trial enrolled 134 patients randomized to three study arms representing the three management methods. These participants were followed for 12 months. Statistical methods: To describe the distributions of the outcome variables, summary statistics were used. For the inferential statistics, comparisons of means across the study arms were performed using ANOVA techniques and comparisons of proportions were performed using Logistic Regression models. Survival analysis techniques, Kaplan Meier curves and Cox Regression, were used to compare the group effect in delaying the timing until the first hospitalization. Results: Throughout the trial, the SC arm was represented with better outcomes for all the outcomes of interest. On average, patients in the SC arm had more hospital free days (335 ± 72), shorter in-hospital length of stay (4 ± 13), fewer hospitalizations (1± 2) and a longer time delay for first hospitalization (139 ± 118) in comparison to the patients in the CM and SM arms. However, the differences were not statistically significant (p-value > 0.05). Conclusion: The results from the current study did not establish if one management program had significantly better outcomes when compared to the other two.

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