Related Experiment Video
Updated: Jan 31, 2026

Author Spotlight: Workflow for Integrating POCUS Data into EHR for Managing Heart Failure Patients
Published on: July 12, 2024
Effectiveness of a community care management program for multimorbid elderly patients with heart failure in the
Silvia Netti Tiozzo1, Cristina Basso2, Giulia Capodaglio2
1Epidemiological Service of the Veneto Region, Azienda Zero, 35131, Padua, PD, Italy. silvia.tiozzonetti@azero.veneto.it.
Background:
The rapidly growing population of elderly subjects with multimorbidity is at risk of receiving fragmented and uncoordinated care, and have frequent hospitalizations and emergency room (ER) visits.
Aims:
The study aims to describe the impact of a care management program (CMP) developed in the Veneto region (Northeastern Italy) for patients affected by chronic heart failure (CHF) and multimorbidity.
Methods:
The CMP was provided to 330 patients > 65 years suffering from CHF and multimorbidity. They were compared to a propensity score matched reference group who received usual care. The intervention was provided by care manager nurses and General Practitioners working in the community. The quality of care from the patients' perspective was assessed by means of the Patient Assessment of Chronic Illness Care (PACIC). The effectiveness of the CMP has been evaluated comparing time changes in hospital admissions in the medical area and ER visits between the intervention and the reference group.
Results:
The median PACIC overall score was 4 out of 5. The intervention group showed a reduction over time by 39% in hospitalization rates and by 33% in ER visits. The recourse to hospital care and ER did not change in the reference group.
Discussion:
The current results indicate that a CMP can reduce Emergency Room visits and hospital admissions for elderly patients with CHF and multimorbidity.
Conclusions:
The CMP by emphasizing prevention, self-management, continuity and coordination of care, is beneficial among older community-dwelling multimorbid persons as compared to usual care.
More Related Videos
10:45A Community-based Stress Management Program: Using Wearable Devices to Assess Whole Body Physiological Responses in Non-laboratory Settings
Published on: January 22, 2018
04:05Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
Published on: June 30, 2023
Related Concept Videos
Heart Failure V: Medical Management
Heart Failure II: Pathophysiology
Pathophysiology of Heart Failure
Heart Failure I: Introduction
Patient-centered Care
Heart Failure VI: Adjunct Therapies