Frontloading and Intensity of Skilled Home Health Visits: A State of the Science

Abstract

Frontloading of skilled nursing visits is one way home health providers have attempted to reduce hospital readmissions among skilled home health patients. Upon review of the frontloading evidence, visit intensity emerged as being closely related. This state of the science presents a critique and synthesis of the published empirical evidence related to frontloading and visit intensity. OVID/Medline, PubMed, and Scopus were searched. Seven studies were eligible for inclusion. Further research is required to define frontloading and visit intensity, identify patients most likely to benefit, and to provide a better understanding of how home health agencies can best implement these strategies.

Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study

“…They described providing early frequent visits to patients with frequent health status fluctuation, such as those with heart failure or any new diagnosis. Nurses from two agencies used the word “frontloading” to refer to this practice, which is consistent with the existing literature (O’Connor et al, 2014). Some of the study participants described it as providing early, frequent visits, while others specified the number of visits, such as at least three times per week, or every other day, or even back-to-back visits.…”

“…Patients receiving HH services have complex needs (Murtaugh et al, 2009) and require different levels of care and attention. Visit intensity specifically refers to the number and frequency of visits that patients receive throughout the 60-day care episode (O’Connor et al, 2014). While there is some available data on the impact of visit intensity on outcomes for HH care in the United States (O’Connor, Hanlon, Naylor, & Bowles, 2015; O’Connor et al, 2014), empirical evidence about nurse decision-making regarding visit intensity planning does not exist.…”

“…Visit intensity specifically refers to the number and frequency of visits that patients receive throughout the 60-day care episode (O’Connor et al, 2014). While there is some available data on the impact of visit intensity on outcomes for HH care in the United States (O’Connor, Hanlon, Naylor, & Bowles, 2015; O’Connor et al, 2014), empirical evidence about nurse decision-making regarding visit intensity planning does not exist. Despite this, nurses are required to make such decisions daily for newly admitted patients, which annually equates to 6.6 million decisions (MedPAC, 2016).…”

Identifying distinct risk profiles to predict adverse events among community-dwelling older adults

“…If independently validated in other studies, these risk profiles could be used by primary care and other community-based clinicians to identify older adults living in the community who may be at risk for poor outcomes and trigger clinicians to initiate individualized, targeted interventions. Targeted interventions may include the initiation, continuation or increased frequency of several community-based services such as nurse-led care coordination, 34 home health care, 39,40 hospice, phone calls between visits, 41 telehealth, 42 physician follow up 43 and handyman services 44 to mitigate risk. Additionally, the risk profiles, if further refined, could be integrated into clinical decision support systems to assist clinicians identify specific community-based referrals needed by older adults according to their level of risk.…”

High-Value Home Health Care for Patients With Heart Failure

“…21 In this study, early and intensive HHC was defined as ≥1 HHC nursing visits within 1 day of hospital discharge for a total of ≥3 visits in the first week after discharge, described as frontloading of HHC visits. 22 In another observational study, a group of 223 patients with HF who received transitional care including a combination of formalized communication between hospital, HHC, and outpatient clinicians; primary care follow-up within 7 days; and frontloading of HHC visits had a lower odds of 30-day hospital readmissions compared with a control group receiving usual care (adjusted odds ratio, 0.57 [95% confidence interval, 0.38–0.87]). 23 Thus, intensive HHC and outpatient clinician follow-up with structured communication between care settings is a promising approach to improve transitional care after discharge for patients with HF.…”