Heart transplant centers with multidisciplinary team show a higher level of chronic illness management - Findings from the International BRIGHT Study

Maan Isabella Cajita; Eva Baumgartner; Lut Berben; Kris Denhaerynck; Remon Helmy; Sandra Schönfeld; Gabriele Berger; Christine Vetter; Fabienne Dobbels; Cynthia L Russell; Sabina De Geest; BRIGHT Study Team

doi:10.1016/j.hrtlng.2017.05.006

Heart transplant centers with multidisciplinary team show a higher level of chronic illness management - Findings from the International BRIGHT Study

Heart Lung. 2017 Sep-Oct;46(5):351-356. doi: 10.1016/j.hrtlng.2017.05.006. Epub 2017 Jun 16.

Collaborators

BRIGHT Study Team:
Maria G Crespo-Leiro⁶, Sandra Cupples⁷, Paolo De Simone⁸, Albert Groenewoud⁹, Christiane Kugler¹⁰, Linda Ohler¹¹, Johan Van Cleemput¹², Alain Jean Poncelet¹³, Laurent Sebbag¹⁴, Magali Michel¹⁵, Andrée Bernard¹⁶, Andreas Doesch¹⁷, Ugolino Livi¹⁸, Valentina Manfredini¹⁹, Vicens Brossa-Loidi²⁰, Javier Segovia-Cubero²¹, Luis Almenar-Bonet²², Carmen Segura Saint-Gerons²³, Paul Mohacsi²⁴, Eva Horvath²⁵, Cheryl Riotto²⁶, Gareth Parry²⁷, Ashi Firouzi²⁸, Stella Kozuszko²⁹, Haissam Haddad³⁰, Annemarie Kaan³¹, Grant Fisher³², Tara Miller³³, Maureen Flattery³⁴, Kristin Ludrosky³⁵, Bernice Coleman³⁶, Jacqueline Trammell³⁷, Katherine St Clair³⁸, Andrew Kao³⁸, Maria Molina³⁹, Karyn Ryan Canales⁴⁰, Samira Scalso de Almeida⁴¹, Andrea Cotait Ayoub⁴², Fernanda Barone⁴³, Michelle Harkess⁴⁴, Joanne Maddicks-Law⁴⁵

Affiliations

¹ School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
² Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.
³ Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
⁴ School of Nursing and Health Studies, University of Missouri-Kansas City, MO, USA.
⁵ Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium. Electronic address: sabina.degeest@unibas.ch.
⁶ Hospital Universitario À Coruña, La Coruña, Spain.
⁷ U.S. Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA.
⁸ Azienda Ospedaliero - Universitaria Pisana, Ospedale Cisanello, Pisa, Italy.
⁹ Astellas Pharma Europe Ltd., UK.
¹⁰ Hannover Medical School, Hannover, Germany.
¹¹ George Washington University, Washington, DC, USA.
¹² University Hospitals Leuven, Leuven, Belgium.
¹³ Cliniques Universitaires Saint - Luc, Brussels, Belgium.
¹⁴ Hôpital Louis Pradel, Lyon, France.
¹⁵ Hôpital Nord Laennec, Nantes, France.
¹⁶ Hôpital Universitaire Pitié - Salpêtrière, Paris, France.
¹⁷ University Hospital Heidelberg, Heidelberg, Germany.
¹⁸ University Hospital Udine, Udine, Italy.
¹⁹ University of Bologna, Bologna, Italy.
²⁰ Hospital de Sant Pau, Barcelona, Spain.
²¹ Hospital Puerta de Hierro, Madrid, Spain.
²² Hospital Universitari i Politècnic La Fe de Valencia, Valencia, Spain.
²³ Hospital Univeritario Reina Sofia, Córdoba, Spain.
²⁴ University Hospital of Bern, Bern, Switzerland.
²⁵ University Hospital Zurich, Zurich, Switzerland.
²⁶ Papworth Hospital, Cambridge, UK.
²⁷ Freeman Hospital, Newcastle, UK.
²⁸ Royal Brompton & Harefield NHS Foundation Trust, London, UK.
²⁹ Toronto General Hospital, Toronto, Canada.
³⁰ University of Ottawa Heart Institute, Ottawa, ON, Canada.
³¹ St Paul's Hospital, Vancouver, BC, Canada.
³² London Health Sciences Centre, London, ON, Canada.
³³ Duke University Hospital, Durham, NC, USA.
³⁴ Virginia Commonwealth University Health System, Richmond, VA, USA.
³⁵ Cleveland Clinic, OH, USA.
³⁶ Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³⁷ Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA.
³⁸ St. Luke's Hospital, Kansas City, MO, USA.
³⁹ Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
⁴⁰ Ochsner Medical Center, New Orleans, LA, USA.
⁴¹ Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁴² Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
⁴³ Instituto do Coração da Universidade de São Paulo, São Paulo, Brazil.
⁴⁴ St. Vincent's Hospital, Sydney, Australia.
⁴⁵ The Prince Charles Hospital, Brisbane, Australia.

PMID: 28624338
DOI: 10.1016/j.hrtlng.2017.05.006

Abstract

Objectives: The objectives of this study were to: (1) explore the proportion of HTx centers that have a multidisciplinary team and (2) assess the relationship between multidisciplinarity and the level of chronic illness management (CIM).

Background: The International Society for Heart and Lung Transplantation (ISHLT) recommends a multidisciplinary approach in heart transplant (HTx) follow-up care but little is known regarding the proportion of HTx centers that meet this recommendation and the impact on patient care. HTx centers with a multidisciplinary team may offer higher levels of CIM, a care model that has the potential to improve outcomes after HTx.

Methods: We conducted a secondary analysis of the BRIGHT study, a cross-sectional study in 11 countries. Multidisciplinarity in the 36 HTx centers was assessed through HTx director reports and was defined as having a team that was composed of physician(s), nurse(s), and another healthcare professional (either a social worker, psychiatrist, psychologist, pharmacist, dietician, physical therapist, or occupational therapist). CIM was assessed with the Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression assessed the relationship between multidisciplinarity and the level of CIM.

Results: Twenty-nine (80.6%) of the HTx centers had a multidisciplinary team. Furthermore, multidisciplinarity was significantly associated with higher levels of CIM (β = 5.2, P = 0.042).

Conclusion: Majority of the HTx centers follows the ISHLT recommendation for a multidisciplinary approach. Multidisciplinarity was associated with CIM and point toward a structural factor that needs to be in place for moving toward CIM.

Keywords: Chronic illness management; Heart transplantation; Multidisciplinary teams.

Publication types

Multicenter Study

MeSH terms

Chronic Disease / therapy*
Cross-Sectional Studies
Delivery of Health Care / standards*
Disease Management*
Female
Heart Transplantation*
Humans
Male
Middle Aged
Multivariate Analysis
Patient Care Team / standards*

Grants and funding

F31 NR015943/NR/NINR NIH HHS/United States