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Combining heart failure education with real-time communication tools can better equip home health aides (HHAs) to care for adults with heart failure in the home, according to a pilot randomized clinical trial conducted by researchers in the Division of General Internal Medicine at Weill Cornell Medicine and VNS Health, one of the largest home care agencies in the United States, located in New York City. The study, published in JAMA Network Open, was funded by National Heart, Lung, and Blood Institute.
As healthcare increasingly shifts toward home-based models, this study underscores a critical message: empowering home health aides through targeted training and communication tools may offer a novel and sustainable way to improve heart failure care at home.
Heart failure affects more than 6 million Americans and remains a leading cause of hospitalization among older adults. While prior research focused on reducing readmissions, which has often centered on hospital-based interventions, home-based care often gets less attention. HHAs are vital in monitoring symptoms of patients with heart failure, supporting daily care and ensuring treatment and medication adherence. Prior research has found that, despite providing this care, HHAs lack formal training for heart failure care and often struggle to reach nurses and doctors by telephone when they need help or have questions.
To address these challenges, Dr. Madeline Sterling, associate professor of medicine, along with Drs. Monika Safford, professor of medicine and director of research and Lisa Kern, professor of medicine in the Division of General Internal Medicine at Weill Cornell, collaborated with Margaret McDonald, associate vice president at VNS Health. They conducted a pilot two-arm randomized controlled trial (RCT) with HHAs employed by VNS Health who were caring for adults with heart failure.
HHAs were assigned to either the Enhanced Usual Care (EUC) arm, a structured heart failure training program or the Intervention arm, which included the training program plus a mobile health (mHealth) app that enabled real-time messaging with nurse supervisors at VNS Health.
Outcomes were measured at the start of the study, mid-study (45 days) and 90 days, assessing HHAs’ knowledge of heart failure, confidence in providing heart failure care and frequency of preventable 911 calls. Patient outcomes, including emergency room visits and hospitalizations, were discussed in an exploratory fashion.
Results were encouraging and demonstrated that HHAs who received training had greater knowledge and confidence. Furthermore, HHAs with both training and the mHealth app had fewer preventable 911 calls compared with those receiving training alone. The study team found a trend that patients with HHAs in the intervention arm of the study had 44% reduced risk of emergency visits, even though the pilot trial was not powered for patient-level outcomes. “These results show that training and integrating HHAs into care teams can improve the care delivered to patients at home,” Dr. Sterling said. McDonald also added, “HHAs are often the first to notice changes in patients and timely access to a nurse can help prevent crises.”
The research team plans to expand this work into a larger trial to confirm these findings and formally evaluate the impact on patient outcomes, such as hospitalizations and emergency department visits, as well as communication patterns with ambulatory and primary care providers.
