Person-Centered Care in the Home Setting for Parkinson’s Disease: Operation House Call Quality of Care Pilot Study

Abstract

Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program.

Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

“…Two studies reported the use of information technology–based platforms for the monitoring of patients’ day‐to‐day needs, coordination and feedback from the care provider, one utilized a telehealth solution . Other care coordination models used a ‘one‐stop‐clinic’ approach, where care providers from multiple domains met the patient at the same location over a day or two . Two models furthered this approach by taking health care provider teams to the patient's home .…”

“…Other care coordination models used a ‘one‐stop‐clinic’ approach, where care providers from multiple domains met the patient at the same location over a day or two . Two models furthered this approach by taking health care provider teams to the patient's home . Yet another model of care coordination involved initial management at expert centers followed by routine care delivery at the community level through an integrated network of allied health care professionals .…”

Moving Parkinson care to the home

“…Individuals who are older and have more chronic conditions are less likely to use the internet, 46,47 and the digital divide has hampered efforts to use technology to deliver PD care at home. 48 The divide can be overcome by delivering in-person home care to individuals with PD, 49 providing remote care via satellite clinics close to one’s home as is done in Canada, 22,37 engaging children in the care of their parents, and increasing access to telecommunication technologies. The digital divide is narrowing and the increasing ubiquity of smartphones, which are projected to be in the hands of 90% of individuals over age 6 by 2020, 50 provides a promising avenue to increase access to care, especially in resource limited countries like China and India.…”

A New Day: The Role of Telemedicine in Reshaping Care for Persons With Movement Disorders

“…24 For some patients, care could be delivered in their own home. 25 In the 1930s, the house call was the primary means of providing care, and 40% of patientphysician encounters occurred there. 26 Dr. Jori Fleisher and colleagues have demonstrated the feasibility and value of providing such care from a Parkinson' specialist, nurse, and social worker.…”