Comparing Coaches and Smart Phone Technology To Optimize Chronic Disease Management in Congestive Heart Failure
James E Calvin

Transformation:The use of both coaches and smart phone technology to assist heart failure(HF) patients in the self management of their disease expands our ability to chronically care for HF patients. Our hypothesis is that one or both will be successful at improving patient adherence and will reduce re-admission. A key innovation with both interventions is the effective breaking down of the barrier of mistrust, with improved communication, education, and motivation of patients in their own environment .  A second innovation is that the link to needed medical care we would propose reduces the burden on the high risk patients by using alternatives to traditional health system means.Adoptability: These methodologies can be applied elsewhere in the province, urban or rural.Outcomes: We expect to improve patient adherence and reduce admissions.

Congestive Heart Failure continues to be increasing in incidence in Canada and the United States and is one of the most common reasons for hospital admission and re-admission. Many methods have been proposed to reduce hospital admission of heart failure patients including nurse led clinics, tele-monitoring and telephone support. In this project we propose to develop  and compare 2 novel  approaches to chronic out-patient management of heart failure patients, coaches and smart phone technology.The latter two approaches have been tested in other clinical situations with some success in changing patient behavior such as medication adherence and lifestyle change. Both of these should improve successful patient self management, an important pillar of chronic disease management. Coaches(lay peers) under guidance of an advance practice nurse will be educated in both heart failure and disease management and tested for knowledge and their ability to change patient behavior. They will be compared to a smart phone intervention aimed at reminding patients about testing and medication schedules and taught through text messaging about their disease.We will assess patient knowledge aquisition,and adherence. Finally, we will determine re-admission rates for both interventions for designing a future outcome trial.