Amber Bennett OTD, OTR/L (she/her/hers)

As the U.S. population shifts away from a White majority, it is imperative that the health care workforce reflect the diversity of client populations served. Increased diversity in the health care workforce fosters access to more personalized, culturally responsive, and client-centered care, thereby facilitating improved outcomes and reduced health disparities. Occupational therapy education programs function as gatekeepers for diversity and need to be accountable for representation in the profession and to produce graduates who reflect the diversity of the broader population. Holistic admission practices, which ensure that no single factor excludes an applicant from admission, are recognized as a meaningful strategy for increasing student diversity in higher education and provide a pathway to create a representative workforce with the ability to improve care disparities and client outcomes. As one of the largest occupational therapy programs in the country, and located in a diverse urban area, the University of Southern California’s Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy has embraced the profession’s responsibility toward greater health equity through holistic admissions. In this column, we discuss holistic admission best practices and report diversity outcomes resulting from enactment of these practices within our occupational therapy education program.

Introduction. Hospitalizations for heart failure (HF) are the highest single Medicare expenditure. This cost primarily results from readmissions linked to failed self-care. Evidence suggests that effective self-care routines are equivalent to medication in preventing HF exacerbation and hospitalization. Occupational therapists (OT) are well suited to address HF self-care needs by facilitating self-efficacy and adapting patients’ routines, roles and habits. A recent study determined that OT is the only hospital spending category associated with lower HF readmission rates.

Hypothesis. Occupational therapy has a significant role in addressing the self-care management needs of patients with HF throughout the continuum of care.

Methods. The OT department launched a HF self-care management program as part of process improvement initiatives at an AHA-recognized teaching hospital. An assessment battery was developed which included the following: The Self-Care of Heart Failure Index (SCHFI) v.6.2, Minnesota Living With Heart Failure Questionnaire, Patient Health Questionnaire-9, and the Montreal Cognitive Assessment. Administration of the OT HF assessment battery to a pilot group of 12 inpatients revealed factors that affect patient adoption and adherence to beneficial self-care management routines. Based on assessment battery data, an outpatient OT program was established. Eleven outpatients were enrolled and completed 3-6 hours of OT treatment. The SCHFI was administered at program evaluation and completion to measure self-care maintenance and confidence. To expand service access, a telehealth self-care program was introduced and a single patient case study was assessed to determine the feasibility and effectiveness of the virtual format.

Results. Assessment battery data enabled the development of outpatient treatment modules focusing on symptom monitoring, medication management, low sodium diet, activity tolerance and psychosocial strategies. All outpatients who completed the modules demonstrated improved self-care maintenance (ranging from 16-53 points) and half demonstrated improved self-care confidence (ranging from 6-39 points). The patient assessed after completing the telehealth program demonstrated improved self-care maintenance (70 points) and self-care confidence (28 points).

Conclusions. In conclusion, OT has a significant role in addressing the self-care management needs of patients with HF throughout the continuum of care. The utilization of a standardized OT HF assessment battery is effective in determining the needs of this population and for guiding the implementation of targeted individualized treatment. Outpatient and telehealth delivery of OT programming is effective in improving self-care for people with HF.

Objective. To demonstrate the effectiveness of an outpatient occupational therapy program on improving self-care for individuals with heart failure.

Background. Hospitalizations for heart failure (HF) are the largest Medicare expenditure, and 12% of these admissions are considered preventable. Effective self-management of the debilitating symptoms associated with HF (shortness of breath, fatigue, fluid retention, cognitive decline) helps keep patients out of the hospital. Individuals often experience difficulty incorporating self-care management activities into their daily lives. Occupational therapy (OT) is well suited to address the self-care needs of people with HF by increasing patient self-efficacy and facilitating lifestyle modification through the incorporation of new habits, roles, and routines.

Methods. Participants with HF (n=11, ages 40-86) enrolled in an outpatient OT program focusing on self-care management. Participants received weekly, bi-weekly or monthly one-hour treatments over a six-month period. Sessions addressed the following topics: low sodium diet adherence, medication management, activity tolerance, symptom monitoring and psychosocial coping strategies. The Self-Care of Heart Failure Index (SCHFI) was administered at evaluation and upon completion of the program. The SCHFI is a reliable and valid assessment tool that measures self-care maintenance, management and confidence in people with HF.

Results. All participants who received two or more treatments demonstrated 33.33% (16.67 of 49.99) to 190.01% (63.33 of 33.33) improvement in maintenance of self-care routines based on pre and post SCHFI scores. Additionally, half of these participants demonstrated 28.47% (22.16 of 77.84) to 85.33% (38.4 of 45) improvement in confidence with self-care management based on pre and post SCHFI scores.

Conclusion. Participation in an outpatient OT program that focused on incorporating lifestyle modifications into daily routines was effective at improving self-care for people with HF, specifically maintenance of self-care routines and confidence with ability to self-manage their chronic condition.