Patrick Dunn

Defining a Mobile Health Roadmap for Cardiovascular Health and Disease

Mobile telecommunication technologies have spurred growth and innovation in multiple sectors including commerce, media, and finance. Arguably, health care is the sector in which the potential of these new technologies is both the greatest and the most unrecognized. With the rapid adoption of

Design and Rationale of a Randomized Trial of a Care Transition Strategy in Patients with Acute Heart Failure Discharged from the Emergency Department: GUIDED-HF (Get with the Guidelines in Emergency Department Patients with Heart Failure)

GUIDED-HF (Get With the Guidelines in Emergency Department Patients With Heart Failure) is a multicenter randomized trial of a patient-centered transitional care intervention in patients with acute heart failure (AHF) who are discharged either directly from the emergency department (ED) or after a brief period of ED-based observation. To optimize care and reduce ED and hospital revisits, there has been significant emphasis on improving transitions at the time of hospital discharge for patients with HF. Such efforts have been almost exclusively directed at hospitalized patients; individuals with AHF who are discharged from the ED or ED-based observation are not included in these transitional care initiatives. Patients with AHF discharged directly from the ED or after a brief period of ED-based observation are randomly assigned to our transition GUIDED-HF strategy or standard ED discharge. Patients in the GUIDED arm receive a tailored discharge plan via the study team, based on their identified barriers to outpatient management and associated guideline-based interventions. This plan includes conducting a home visit soon after ED discharge combined with close outpatient follow-up and subsequent coaching calls to improve postdischarge care and avoid subsequent ED revisits and inpatient admissions. Up to 700 patients at 11 sites will be enrolled over 3 years of the study. GUIDED-HF will test a novel approach to AHF management strategy that includes tailored transitional care for patients discharged from the ED or ED-based observation. If successful, this program may significantly alter the current paradigm of AHF patient care. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02519283.

Improving health literacy in patients with chronic conditions: A call to action

Knowledge and education is foundational to an individual receiving care, and health literacy is the ability of patients to understand and act on health information. Cardiovascular disease and diabetes are complex conditions that require active participation on the part of the patient. Lack of understanding on the condition and participation in self-care behaviors limits the effectiveness of treatment. An effective model is needed to better understand how patients with cardiovascular disease and diabetes acquire the knowledge and skills necessary to manage their health. In working together, the authors have created multiple programs that have been delivered at medical offices and corporations, resulting in a model for building functional and critical health literacy skills. This model is a progression that begins with health literacy, including the knowledge and understanding of the condition. Functional literacy includes numeracy, which is the ability to understand and manipulate numbers, and navigation, which is an understanding of what to do with the information. Finally, critical health literacy includes communication skills, including knowing what questions to ask and what information to share, and decision making, which can include shared decision making. These five levels of health literacy form a progression in the ability of the patient to become an active participant in their care, and inform the healthcare provider on effective educational methods.