Abstract
IMPORTANCE: Home health aides (HHAs) frequently care for adults with heart failure (HF), but many lack HF training, confidence with HF caregiving, and cannot reach their nurse supervisors by telephone when they need guidance. This may have negative consequences for HHAs and patients. OBJECTIVE: To examine the effectiveness of an education- and communication-based intervention among HHAs caring for patients with HF. DESIGN, SETTING, AND PARTICIPANTS: This 2-group pilot randomized clinical trial was conducted in partnership with a large home care agency in New York, New York, from May 2022 to May 2024. HHAs caring for a patient with HF participated. Outcomes were ascertained on an intent-to-treat basis at baseline, mid-study (45 days after the training course), and 90 days. INTERVENTIONS: The enhanced usual care (EUC) group received HF training, and the intervention group received HF training plus a mobile health application that allowed HHAs to message nurses. MAIN OUTCOMES AND MEASURES: Co-primary outcomes were HF knowledge (assessed using the Dutch HF Knowledge Scale [DHFKS]; range 0-15; higher score indicates greater knowledge) and HF caregiver self-efficacy (assessed using the Caregiver Contribution to Self-Care in HF Index; range, 0-100; higher score indicates greater efficacy). The secondary outcome was self-reported preventable 911 calls. Exploratory outcomes included patient emergency department (ED) visits and hospitalizations. Mixed-effects models were used to compare trajectories of outcomes between and within study groups. RESULTS: A total of 102 HHAs (mean [SD] age, 54 [10.5] years; 98 [96.1%] female) were assessed, including 50 in the EUC group and 52 in the intervention group. Overall, 62 HHAs (62.0%) were Black, 1 HHA (1.0%) was American Indian or Alaska Native, 7 HHAs (7.0%) were Asian, 9 HHAs (9.0%) were White, and 21 HHAs (21.0%) identified as other race; 27 HHAs (27.0%) were Hispanic. Within the intervention group, DHFKS scores improved at 90 days, from a median (IQR) score of 6.1 (5.5-6.7) points at baseline to 7.7 (7.0-8.4) points at 90 days (P = .02); however the change did not differ between groups. Across both groups, HHAs with the lowest baseline DHFKS and self-efficacy had the greatest increases at 90 days (median [IQR] change: DHFKS, 1.45 [0.84-2.04] points; self-efficacy, 8.06 [4.42-11.71] points). At 90 days, there were no statistically significant within-group differences in the proportion of HHAs reporting preventable 911 calls group (intervention: 0.51 [95% CI, 0.37-0.64] at baseline vs. 0.34 [95% CI, 0.2-0.49] at 90 days; P = .06; EUC: 0.42 [95% CI, 0.28-0.56] at baseline vs 0.54 [95% CI, 0.38-0.70] at 90 days; P = .21), but the difference between groups was statistically significant (P = .04). This pilot study was not powered for patient-level outcomes, so the risk of ED visits for patients of intervention HHAs (incidence rate ratio, 0.56 [95% CI, 0.25-1.28]; P = .17) should be considered exploratory. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of HHAs caring for patients with HF, HF training improved HHAs' knowledge and self-efficacy, with greatest gains among those with the lowest baseline scores. The ability to message nurses was associated with fewer preventable 911 calls among HHAs in the intervention group. These findings can inform the design of a large-scale trial to better support and integrate HHAs providing HF care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04239911.