BACKGROUND: With rapidly growing numbers of homebound older adults, the need for effective home-based health interventions is increasingly recognized. Advanced practice registered nurses (NPs) are one of the most common providers of home-based primary care. Limited information is available to address the scope and nature of NP-led home-based primary care and associated outcomes. OBJECTIVE: To synthesize research evidence of NP visits in home-based primary care. DATA SOURCES: Six electronic databases-PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Web of Science, and Scopus-were searched to identify peer-reviewed research articles addressing home-based primary care interventions led by NPs. Independent screening resulted in 17 relevant articles from 14 unique studies to include in the review. CONCLUSIONS: Nurse practitioners provided health assessments, education, care planning and coordination primarily by face-to-face home visits. Despite a variability in terms of study design, setting, and sample, NP-led home-based primary care was in general associated with less hospitalization and fewer emergency department visits. Evidence was mixed in relation to patient-reported outcomes such as subjective health, functional status, and symptoms. Costs and patient or caregiver satisfaction were additional outcomes addressed, but the findings were inconsistent. IMPLICATIONS FOR PRACTICE: Recent policy changes to authorize NPs to independently assess, diagnose, and order home care services directly affect how NPs approach home-based primary care programs. Our findings support NP-led home-based primary care to decrease consequential health utilization and suggest the need for further evaluating the care models in diverse populations with more patient-reported and caregiver outcomes.
BACKGROUND: With rapidly growing numbers of homebound older adults, the need for effective home-based health interventions is increasingly recognized. Advanced practice registered nurses (NPs) are one of the most common providers of home-based primary care. Limited information is available to address the scope and nature of NP-led home-based primary care and associated outcomes. OBJECTIVE: To synthesize research evidence of NP visits in home-based primary care. DATA SOURCES: Six electronic databases-PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Web of Science, and Scopus-were searched to identify peer-reviewed research articles addressing home-based primary care interventions led by NPs. Independent screening resulted in 17 relevant articles from 14 unique studies to include in the review. CONCLUSIONS: Nurse practitioners provided health assessments, education, care planning and coordination primarily by face-to-face home visits. Despite a variability in terms of study design, setting, and sample, NP-led home-based primary care was in general associated with less hospitalization and fewer emergency department visits. Evidence was mixed in relation to patient-reported outcomes such as subjective health, functional status, and symptoms. Costs and patient or caregiver satisfaction were additional outcomes addressed, but the findings were inconsistent. IMPLICATIONS FOR PRACTICE: Recent policy changes to authorize NPs to independently assess, diagnose, and order home care services directly affect how NPs approach home-based primary care programs. Our findings support NP-led home-based primary care to decrease consequential health utilization and suggest the need for further evaluating the care models in diverse populations with more patient-reported and caregiver outcomes.
Authors: Girish Valluru; Jean Yudin; Christine L Patterson; Joanna Kubisiak; Peter Boling; George Taler; Karl Eric De Jonge; Steve Touzell; Ann Danish; Katherine Ornstein; Bruce Kinosian Journal: J Am Geriatr Soc Date: 2019-05-10 Impact factor: 5.562
Authors: Christopher Crowley; Amy R Stuck; Tracy Martinez; Alan C Wittgrove; Feng Zeng; Jesse J Brennan; Theodore C Chan; James P Killeen; Edward M Castillo Journal: J Emerg Med Date: 2016-09-28 Impact factor: 1.484
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Authors: Ji E Chang; Alden Yuanhong Lai; Avni Gupta; Ann M Nguyen; Carolyn A Berry; Donna R Shelley Journal: Milbank Q Date: 2021-06-01 Impact factor: 6.237