Home-Based Disease Management in Congestive Heart Failure

Abstract

Disease management programs have emerged as a comprehensive strategy to decrease costs and increase quality of care for patients with chronic diseases. It is a long-term strategy that emphasizes patient involvement in his or her own care and early recognition of potential worsening of the condition. Disease management programs address more than just the educational needs of patients by intervening before the problems get out of control. Because of their role in patients’ homes and lives, home care nurses are ideal agents of disease management. This discussion presents a comparison of disease management in home care and proposes a way for the best of both entities to be combined in the setting of congestive heart failure (CHF). The program developed at the Visiting Nurse Association of Maryland is presented as an example of how the two can be blended to address the complex problems of patients with CHF.