Home Visit Models Save Money, Reduce ED Visits, Hospitalizations

Home visits by teams led by registered nurses or lay health workers can also reduce costs and utilization of services, such as emergency department (ED) visits and hospitalizations, according to a paper published in Health Affairs.

Past research on home-based care has focused on care delivered by teams led by primary care providers. The current study evaluated the effectiveness of 5 home visit models under the Health Care Innovation Awards of CMS. The models used patient-extender teams to provide care to Medicare beneficiaries and address aspects of service delivery not based in primary care.

“Home visits offer an opportunity to reach high-risk, high-needs patients before a change in condition necessitates a higher level of care and can mitigate access barriers such as lack of transportation or limited mobility,” the authors wrote.

The models studied were:

• Indiana University’s Aging Brain Care (ABC), targeting care toward patients with dementia, depression, or both. Lay workers lead this program, which receives referrals through the university’s brain care center.
• Ochsner Health System’s Stroke Mobile, targeting care toward patients recovering from stroke. Lay workers lead this program. Staff members identified participants when they were admitted to the health system with a stroke diagnosis.
• Palliative Care Consultants of Santa Barbara’s Doctors Assisting Seniors at Home (DASH), offering a subscription-based service to help older adults avoid visits to the ED. Registered nurses lead this program. Patients were referred from senior housing managers and community partners.
• The Johns Hopkins University School of Nursing’s Community Aging in Place, Advancing Better Living for Elders (CAPABLE), focusing on beneficiary-directed functional improvements tied to the home environment. Registered nurses lead this program. Patients were recruited as part of a trial with the National Institute on Aging.
• Sutter Health’s Advanced Illness Management (AIM), serving as a bridge between hospital and hospice care for patients with late-stage illness. Registered nurses lead this program. Referrals were solicited from providers of participants in the system who met criteria related to late-stage prognosis.

The 5 models addressed 6 categories of needs: care coordination, beneficiary or caregiver education, referrals to home and community-based services and supports, disease management, advance care planning, and environmental assessment or redesign.

The researchers determined that 4 of the models reduced total Medicare expenditures or utilization. CAPABLE reduced total expenditures relative to comparators and reduced readmissions and observation stays. DASH had significant reductions in ED visits and hospitalizations. AIM had a significant reduction in hospitalizations and Medicare expenditures in the last 30 days of life. Stroke Mobile significantly reduced readmissions. No significant findings were observed for ABC.

“Though the models shared key components related to care coordination and patient/consumer engagement, given the models’ diversity in target populations, staffing, and set of components, it is important to consider each home visit model on its own terms," the author concluded. "The similarities among models that were correlated with positive findings present a strong case for considering the value of having practice extenders provide home visits."