The outcomes of nurse practitioner (NP)-Provided home visits: A systematic review

Abstract

Background With the shortage of primary care providers to provide home-based care to the growing number of homebound older adults in the U.S. Nurse Practitioners (NPs) are increasingly utilized to meet the growing demand for home-based care and are now the largest type of primary care providers delivering home-visits. Purpose The purpose of this study was to systematically examine the current state of the evidence on health and healthcare utilization outcomes associated with NP-home visits. Method Five Databases (PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library) were systematically searched to identify studies examining NP-home visits. The search focused on English language studies that were published before April 2019 and sought to describe the outcomes associated with NP-home visits. We included experimental and observational studies. Quality appraisal was performed with the Kmet, Lee & Cook tool, and results summarized qualitatively. The impact of NP-home visits on clinical (functional status, quality of life [QOL]), and healthcare utilization (hospitalization, Emergency department(ED) visits) outcomes was evaluated. Results/Discussion A total of 566 citations were identified; 7 met eligibility criteria and were included in the review. The most commonly reported outcomes were emergency department (ED) visits and readmissions. Given the limited number of articles generated by our search and wide variation in intervention and outcomes measures. NP-home visits were associated with reductions in ED visits in 2 out of 3 studies and with reduction in readmissions in 2 out of 4 studies. Conclusion Published studies evaluating the outcomes associated with NP-home visits are limited and of mixed quality. Limitations include small sample size, and variation in duration and frequency of NP-home visits. Future studies should investigate the independent effect of NP-home visits on the health outcomes of older adults using large and nationally representative data with more rigorous study design.

Home-based primary care visits by nurse practitioners

“…Two studies that measured objective health outcomes found a greater decrease in hemoglobin A1c (Stone et al, 2010) or more health risk reduction among intervention participants (Hahn & Aronow, 2005). Palfrey et al (2004) found that providing NP home visits to children with special needs significantly improved school and work attendance for children and parents. Finally, one study found that children with asthma had fewer courses of oral steroids, fewer nighttime symptoms, and better asthma control (Swartz & Meadows-Oliver, 2019).…”

“…Ten of 12 studies addressing health care utilization found that NP home visits led to fewer hospitalizations ( n = 10) (Bryant & Gaspar, 2014; Dick & Frazier, 2006; Jones, DeCherrie, et al, 2017; Kobb et al, 2003; Muramatsu et al, 2004; Palfrey et al, 2004; Stuck et al, 1995; Swartz & Meadows-Oliver, 2019; Wajnberg et al, 2010). The intervention group in the two studies without significant utilization changes had a trend of decreased hospitalizations (Coppa et al, 2018; Counsell et al, 2007).…”

“…The health status outcomes encompassed subjective overall health ( n = 4) (Counsell et al, 2007; Dick & Frazier, 2006; Muramatsu et al, 2004; Zimmer et al, 1985), functional status ( n = 3) (Counsell et al, 2007; Kobb et al, 2003; Stuck et al, 1995), objective health outcomes (i.e., hemoglobin A1c, health risk reduction) ( n = 2) (Hahn & Aronow, 2005; Stone et al, 2010), self-reported illness measure (Palfrey et al, 2004), or both self-reported symptoms and objective treatment level (Swartz & Meadows-Oliver, 2019). Health status was determined mostly from participant-reported or caregiver-reported data ( n = 6) (Counsell et al, 2007; Hahn & Aronow, 2005; Kobb et al, 2003; Palfrey et al, 2004; Stuck et al, 1995; Swartz & Meadows-Oliver, 2019). To retrieve patient health status, studies used medical records ( n = 2) (Stone et al, 2010; Swartz & Meadows-Oliver, 2019) or qualitative data from individual and/or focus group interviews with NPs ( n = 2) (Dick & Frazier, 2006) or from both NPs and patients (Muramatsu et al, 2004).…”

“…Eleven of 14 studies included in the review were rated as high quality (Bryant & Gaspar, 2014; Coppa et al, 2018; Counsell et al, 2007; Dick & Frazier, 2006; Jones, DeCherrie, et al, 2017; Kobb et al, 2003; Palfrey et al, 2004; Stone et al, 2010; Stuck et al, 1995; Swartz & Meadows-Oliver, 2019; Wajnberg et al, 2010), and three studies were rated as medium quality (Dick & Frazier, 2006; Hahn & Aronow, 2005; Zimmer et al, 1985). Of the 11 high-quality studies, 3 were RCTs (Counsell et al, 2007; Stanhope et al, 2018; Stuck et al, 1995), 7 were quasiexperimental (Bryant & Gaspar, 2014; Coppa et al, 2018; Jones, DeCherrie, et al, 2017; Kobb et al, 2003; Palfrey et al, 2004; Swartz & Meadows-Oliver, 2019; Wajnberg et al, 2010), and 1 was qualitative (Dick & Frazier, 2006). Of the three medium-quality studies, 1 was an RCT (Zimmer et al, 1985), 1 was quasiexperimental (Hahn & Aronow, 2005), and 1 was qualitative (Muramatsu et al, 2004).…”

“…However, our review revealed that the caregiver burden has been understudied. Only two studies have included caregivers' satisfaction with the intervention (Palfrey et al, 2004; Zimmer et al, 1985) and only one assessed the caregivers' burden (i.e., parental workdays) (Palfrey et al, 2004). Future research is warranted to investigate how NP-led home-based primary care may be beneficial not only to chronically ill, homebound patients but also to their caregivers.…”