Using Nurse Practitioner Co-Management to Reduce Hospitalizations and Readmissions Within a Home-Based Primary Care Program

Jones, Masha G.; DeCherrie, Linda V.; Meah, Yasmin; Hernandez, Cameron R.; Lee, Eric J.; Skovran, David; Soriano, Theresa; Ornstein, Katherine

doi:10.1097/jhq.0000000000000059

Cited by 15 publications

(17 citation statements)

References 30 publications

(41 reference statements)

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“…The intervention aimed to reduce the symptom burden and hospitalizations of these patients by increasing home visit frequency, promptly addressing patient issues, and providing more intensive care in the post-discharge period. Though our work to date demonstrates a positive impact of co-management on healthcare utilization, 19 further studies should continue to assess healthcare outcomes and costs with greater duration of patient enrollment in co-management. The NP co-management model at MSVD addressed the needs of a complex and vulnerable subset of patients.…”

Section: Discussionmentioning

confidence: 89%

“…MSVD's NP co-management program, which has successfully reduced healthcare utilization, 19 addressed the needs of a high-risk subset of homebound patients in several ways. As in similar interventions, 25 MSVD's co-management patients received more frequent home visits due to increased visits by the NP.…”

Section: Discussionmentioning

confidence: 99%

“…The intervention has resulted in reductions in annual hospitalization and readmission rates at 18 months follow up. 19 …”

Section: Introductionmentioning

confidence: 99%

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Characterizing the high-risk homebound patients in need of nurse practitioner co-management

et al. 2017

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By providing more frequent provider visits, prompt responses to acute issues, and care coordination, nurse practitioner (NP) co-management has been beneficial for the care of chronically ill older adults. This paper describes the homebound patients with high symptom burden and healthcare utilization who were referred to an NP co-management intervention and outlines key features of the intervention. We compared demographic, clinical, and healthcare utilization data of patients referred for NP co-management within a large home-based primary care (HBPC) program (n=87) to patients in the HBPC program not referred for co-management (n=1027). A physician survey found recurrent hospitalizations to be the top reason for co-management referral and a focus group with nurses and social workers noted that co-management patients are typically those with active medical issues more so than psychosocial needs. Co-management patients are younger than non-co-management patients (72.31 vs. 80.30 years old, P<0.001), with a higher mean Charlson comorbidity score (3.53 vs. 2.47, P=0.0001). They have higher baseline annual hospitalization rates (2.27 vs. 0.61, P=0.0005) and total annual home visit rates (13.1 vs. 6.60, P=0.0001). NP co-management can be utilized in HBPC to provide intensive medical management to high-risk homebound patients.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Characterizing the high-risk homebound patients in need of nurse practitioner co-management

et al. 2017

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“… 19 , 20 A growing body of evidence has demonstrated that HBMC programs lead to reduction in hospitalizations, 30‐day readmissions, and potentially preventable hospitalizations. 20 , 21 , 22 , 23 , 24 …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“… 14 Collaboration between a physician and an advanced practice provider (APP) in shared care of a panel of patients is an example of a teamlet that has demonstrated improved quality measures and provider and patient satisfaction. 21 , 22 Expanding non-face-to-face access within such teams with established provider–patient relationships may further enhance care delivery. 15 Specifically, use of telephone and online encounters to meet patients’ needs can improve access, efficiency, continuity, and timeliness of visits.…”

Section: Introductionmentioning

confidence: 99%

Utilization Outcomes of a Pilot Primary Care Team Redesign

Landrey

Harder

Sandoval

et al. 2018

Health Services Research and Managerial Epidemiology

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Objectives:To evaluate the effect of a team-based primary care redesign on primary care, emergency department (ED) and urgent care (UC) utilization, and new patient access to primary care.Study Design:A retrospective pre–post difference-in-differences analysis of utilization outcomes for patients on a redesigned primary care team compared to a standard primary care group.Methods:Within a patient-centered medical home, a pilot team was developed comprising 2 colocated “teamlets” of 1 physician, 1 nurse practitioner (NP), 1 registered nurse (RN), and 2 licensed practical nurses (LPNs). The redesigned team utilized physician–NP comanagement, expanded roles for RNs and LPNs, and dedicated provider time for telephone and e-mail medicine. We compared changes in number of office, ED, and UC visits during the implementation year for patients on the redesigned team compared to patients receiving the standard of care in the same clinic. Proportion of new patient visits was also compared between the pilot and the control groups.Results:There were no differences between the redesign group and control group in per-patient mean change in office visits (Δ = −0.04 visits vs Δ = −0.07; P = .98), ED visits (Δ = 0.00 vs Δ = 0.01; P = .25), or UC visits (Δ = 0.00 vs Δ = 0.05; P = .08). Proportion of new patient visits was higher in the pilot group during the intervention year compared to the control group (6.6% vs 3.9%; P < .0001).Conclusions:The redesign did not significantly impact ED, UC, or primary care utilization within 1 year of follow-up. It did improve access for new patients.

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Using Nurse Practitioner Co-Management to Reduce Hospitalizations and Readmissions Within a Home-Based Primary Care Program

Cited by 15 publications

References 30 publications

Characterizing the high-risk homebound patients in need of nurse practitioner co-management

Characterizing the high-risk homebound patients in need of nurse practitioner co-management

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

Utilization Outcomes of a Pilot Primary Care Team Redesign

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