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Is “Teach-Back” Associated With Knowledge Retention and Hospital Readmission in Hospitalized Heart Failure Patients?

White, Matthew RN, NP; Garbez, Roxanne PhD, RN, CNS, NP; Carroll, Maureen RN; Brinker, Eileen MSN, RN; Howie-Esquivel, Jill PhD, RN, NP

Journal of Cardiovascular Nursing: March/April 2013 - Volume 28 - Issue 2 - p 137–146
doi: 10.1097/JCN.0b013e31824987bd

Background: Heart failure (HF) is a chronic and costly condition that affects approximately 5.8 million people in the United States, with an additional 670 000 diagnosed yearly. With high 30-day hospital readmission rates, the importance of determining effective means of preventing readmissions is imperative. Despite published guidelines emphasizing the importance of education in preventing readmissions, the most effective means of educating hospitalized patients with HF about their self-care remains unknown.

Objective: The aim of this study was to determine if hospitalized HF patients educated with the teach-back method retain self-care educational information and whether it is associated with fewer hospital readmissions.

Methods: A prospective cohort study design included 276 patients older than 65 years hospitalized with HF over a 13-month period. Patients were educated and evaluated using the teach-back method as part of usual care. Data on ability to recall educational information while hospitalized and during follow-up approximately 7 days after hospital discharge were collected. Readmissions were confirmed through follow-up telephone calls and review of medical records.

Results: Patients correctly answered 3 of 4, or 75%, of self-care teach-back questions 84.4% of the time while hospitalized and 77.1% of the time during follow-up telephone call. Greater time spent teaching was significantly associated with correctly answered questions (P < .001). Patients who answered teach-back questions correctly while hospitalized and during follow-up had nonsignificant (P = .775 and .609) reductions in all-cause 30-day hospital readmission rates, but a trend toward significance (P = .15) was found in patients who had readmissions for HF.

Conclusions: The teach-back method is an effective method used to educate and assess learning. Patients educated longer retained significantly more information than did patients with briefer teaching. Correctly answered HF-specific teach-back questions were not associated with reductions in 30-day hospital readmission rates. Future studies that include patients randomized to receive usual care or teach-back education to compare readmissions and knowledge acquisition would provide further comparison of teach-back effectiveness.

Matthew White, RN, NP Acute Care Nurse Practitioner, Critical Care Medicine, University of San Francisco Medical Center, California.

Roxanne Garbez, PhD, RN, CNS, NP Associate Professor and Vice Chair of Academic Clinical Programs and Personnel, Acute Care Nurse Practitioner Program, University of California, San Francisco.

Maureen Carroll, RN Heart Failure Program Coordinator, University of California, San Francisco Medical Center.

Eileen Brinker, MSN, RN Heart Failure Program Coordinator, University of California, San Francisco Medical Center.

Jill Howie-Esquivel, PhD, RN, NP Assistant Professor, Acute Care Nurse Practitioner Program, Department of Physiological Nursing, University of California, San Francisco.

The authors have no funding or conflicts of interest to disclose.

Correspondence Matthew White, RN, NP, Critical Care Medicine, University of California San Francisco Medical Center, San Francisco, CA 94143 (

© 2013 Lippincott Williams & Wilkins, Inc.