Community-Informed Interventions for Equitable Congestive Heart Failure Management in Primary Care
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Interviews and group discussion for patients and caregivers, Interviews and group discussion for community health worker and care-team stakeholders.
- Who it may be relevant to
- Registry conditions: Congestive Heart Failure, Heart Failure. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United States
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
The purpose of this study is to expand subject matter expertise and sustained capacity for equity-oriented care within the Advanced Care Ecosystem (ACE) by engaging patients, caregivers, community health workers (CHW), and care-team stakeholders in development work focused on adults living with congestive heart failure (CHF) and adverse social determinants of health (SDoH).
Interventions
- Other Interviews and group discussion for patients and caregivers
Participants will be asked to complete an individual interview or participate in a group discussion lasting approximately 60 to 120 minutes, conducted in person, by telephone, or by Mayo-approved video platform. Interview and discussion guides will include discussion of barriers, facilitators, preferences, priorities, and care gaps related to congestive heart failure self-care, access, transitions of care, community health worker support, caregiver support, social needs, health literacy, languag - Other Interviews and group discussion for community health worker and care-team stakeholders
Participants will be asked to complete an individual interview or participate in a group discussion lasting approximately 60 to 120 minutes. Interview and discussion guides will focus on development of a community health worker competency-based training module and development of workflows for community health workers to support congestive heart failure patients' self-management and care transitions. Participants will provide feedback on implementation barriers and facilitators, including trainin
Primary outcome measures
- Identification of prioritized barriers to self-care [Time frame: Through study completion, an average of 2 years]
Eligibility criteria
Inclusion criteria
Patients living with congestive heart failure (CHF):
- Age 18 years or older.
- Diagnosis or clinical documentation of CHF or heart failure in the Mayo Clinic medical record.
- Empaneled in Mayo Clinic, Rochester, primary care
- Evidence in the EHR of one or more adverse SDoH, elevated utilization, medical/social complexity.
- Able to provide informed consent.
- Able to participate in study procedures.
Caregivers:
- Age 18 years or older.
- Caregiver with relevant lived, caregiving, or community experience related to CHF, and nominated by the patient.
- Able to provide informed consent
- Able to participate in study procedures.
Community health worker and care-team stakeholders:
- Age 18 years or older.
- Current or recent role relevant to CHF care, transitions of care, SDoH, patient education, or CHW workflows.
- Able to provide informed consent
- Able to participate in study procedures.
Exclusion criteria
- Under age 18 years.
- Unable or unwilling to provide informed consent.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Observational model
- Other
Study locations
United States · 1 center
- Mayo Clinic — Rochester
Identifiers
NCT: NCT07730827 · 25-013641