Anita D Misra-Hebert1, Michael B Rothberg2, Jaqueline Fox3, Xinge Ji4, Bo Hu4, Alex Milinovich4, William Zafirau5, Anthony Onuzuruike6, Kurt C Stange7. 1. Department of Internal Medicine, Cleveland Clinic Community Care, USA; Healthcare Delivery and Implementation Science Center, Cleveland Clinic, USA; Center for Value-Based Care Research, Cleveland Clinic Community Care, USA; Department of Quantitative Health Sciences, Cleveland Clinic, USA. Electronic address: misraa@ccf.org. 2. Department of Internal Medicine, Cleveland Clinic Community Care, USA; Center for Value-Based Care Research, Cleveland Clinic Community Care, USA. 3. Center for Value-Based Care Research, Cleveland Clinic Community Care, USA. 4. Department of Quantitative Health Sciences, Cleveland Clinic, USA. 5. Department of Connected Care, Cleveland Clinic Community Care, USA. 6. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. 7. Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA.
Abstract
BACKGROUND: Home visits after hospital discharge may reduce future healthcare utilization. We assessed the association of home visits by advanced practice registered nurses (APRN) and paramedics with healthcare utilization and mortality, and provider and patient experience. METHODS: We conducted a retrospective cohort study using convergent mixed methods in one health system including adult medical patients discharged to home from November 2017-September 2019. We assessed outcomes for home visit vs. matched comparison patients at 30, 90, and 180 days, including hospital admission, emergency department (ED) use, and death: Phase 1 (APRN or paramedic visits assigned by geographic location) and Phase 2 (APRN and paramedic visit teams assigned to patients). Patients declining home visits and those accepting were also compared. Semi-structured interviews were conducted with home visit patients and providers, primary care providers, and nurse care coordinators. RESULTS: In Phase 1, the 101 home visit matched to 303 comparison patients showed no differences in readmissions, ED visits, or death at 30, 90, and 180 days. In Phase 2, 157 home visit matched to 471 comparison patients had fewer 30-day readmissions (19.1% vs. 28.7%, p 0.024) and no differences in other outcomes. Compared with patients declining home visits, patients accepting had lower odds of 30-day readmission. In 44 interviews, themes of Medication Understanding, Knowledge Gap after Discharge, Patient Medical Complexity, Social Context, and Patient Engagement/Need for Reassurance emerged. CONCLUSION: Post-discharge home visits by APRNs and paramedics working together were associated with reduced 30-day readmissions. Identified themes could inform strategies to improve patient support.
BACKGROUND: Home visits after hospital discharge may reduce future healthcare utilization. We assessed the association of home visits by advanced practice registered nurses (APRN) and paramedics with healthcare utilization and mortality, and provider and patient experience. METHODS: We conducted a retrospective cohort study using convergent mixed methods in one health system including adult medical patients discharged to home from November 2017-September 2019. We assessed outcomes for home visit vs. matched comparison patients at 30, 90, and 180 days, including hospital admission, emergency department (ED) use, and death: Phase 1 (APRN or paramedic visits assigned by geographic location) and Phase 2 (APRN and paramedic visit teams assigned to patients). Patients declining home visits and those accepting were also compared. Semi-structured interviews were conducted with home visit patients and providers, primary care providers, and nurse care coordinators. RESULTS: In Phase 1, the 101 home visit matched to 303 comparison patients showed no differences in readmissions, ED visits, or death at 30, 90, and 180 days. In Phase 2, 157 home visit matched to 471 comparison patients had fewer 30-day readmissions (19.1% vs. 28.7%, p 0.024) and no differences in other outcomes. Compared with patients declining home visits, patients accepting had lower odds of 30-day readmission. In 44 interviews, themes of Medication Understanding, Knowledge Gap after Discharge, Patient Medical Complexity, Social Context, and Patient Engagement/Need for Reassurance emerged. CONCLUSION: Post-discharge home visits by APRNs and paramedics working together were associated with reduced 30-day readmissions. Identified themes could inform strategies to improve patient support.
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