Academic journal article Online Journal of Issues in Nursing

Application of a Marketing Concept to Patient-Centered Care: Co-Producing Health with Heart Failure Patients

Academic journal article Online Journal of Issues in Nursing

Application of a Marketing Concept to Patient-Centered Care: Co-Producing Health with Heart Failure Patients

Article excerpt


Increasing numbers of patients are being treated for heart failure each year. One out of four of the heart failure patients who receives care in a hospital is readmitted to the hospital within 30 days of discharge. Effective discharge instruction is critical to prevent these patient readmissions. Co-production is a marketing concept whereby the customer is a partner in the delivery of a good or service. For example, a patient and nurse may partner to co-produce a patient-centered health regimen to improve patient outcomes. In this article we review the cost of treating heart failure patients and current strategies to decrease hospital readmissions for these patients along with the role of the nurse and the concept of co-producing health as related to heart failure patients. Next we describe our study assessing the degree to which discharge processes were coproduced on two hospital units having a preponderance of heart failure patients, and present our findings indicating minimal evidence of co-production. A discussion of our findings, along with clinical implications of these findings, recommendations for change, and suggestions for future research are offered. We conclude that standardized discharge plans lead to a mindset of 'one size fits all,' a mindset inconsistent with the recent call for patient-centered care. We offer co-production as a patient-centered strategy for customizing discharge teaching and improving health outcomes for heart failure patients.

Citation: Leone, R., Walker, C, Curry, L., Agee, E., (April 3, 2012) "Application of a Marketing Concept to Patient-Centered Care: Co-Producing Health With Heart Failure Patients" OJIN: The Online Journal of Issues in Nursing Vol. 17 No. 2.

DOI: 10.3912/OJIN.Vol17No01PPT03

Keywords: patient-centered care, heart failure, discharge teaching, hospital readmission, adherence, cost reduction, improved health outcomes, patient satisfaction, co-production

Heart failure (HF), a chronic disorder in which the heart loses its ability to pump blood efficiently, is a serious threat to the health of almost six million Americans. Over 600,000 patients are newly diagnosed with HF each year (Centers for Disease Control and Prevention TCDCI, 2010) and a million patients are hospitalized each year for HF (Hines, Yu, & Randall, 2010). Although HF is not curable, management of symptoms is possible with medication, lifestyle changes, and correction of underlying disorders or comorbidities (Medline Plus, 2010). The purpose of this article is to introduce the concept of co-production and to assess the degree to which discharge processes were co-produced on two hospital units with a preponderance of heart failure patients. Table 1 presents a discussion of the concept of co-production.

The Cost of Heart Failure

In 2010 the estimated cost of HF in the United States (US) was $39.2 billion in direct costs (e.g. health care services) and indirect costs (e.g. lost work productivity) (CDC, 2010; Lloyd-Jones et al., 2010). According to the CDC (2010) one in four patients treated for HF within a hospital is readmitted within 30 days. Medicare readmissions alone increased costs $17.4 billion during 2009 (Hines, Yu, & Randall, 2010). Given the aging of the American population, the incidence of HF is projected to increase markedly during the next decade, yielding higher hospital admission rates and increased cost for Medicare and other third party payers. Interventions are needed to reduce patient readmissions and contain costs.

Strategies to Reduce Readmission

Patient and family participation in health care can enhance self-management strategies so as to improve patients' health status and quality of life (The Joint Commission TTJCI, 2006). Hughes (2011) has noted that "patient- and familycentered care is generally understood to be an approach in which patients and their families are considered integral components of the healthcare decision making and delivery process" (p. …

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