VNA HouseCalls of Greater Cleveland, Ohio: Development and Pilot Evaluation of a Program for High-Risk Older Adults Offering Primary Medical Care in the Home

Abstract

The need for primary medical care in the home will increase with a growing elderly and disabled population. The effectiveness of the service must be assessed in light of its relatively high costs. The aim of this study was to evaluate VNA HouseCalls of Greater Cleveland, Ohio during its first year of operations. The program targets high-risk older adults using teams of advanced practice nurses and physicians. The pilot evaluation focused on the attainment of identified program goals. Data collection techniques included clinical record review (N = 139), mailed referral source satisfaction survey, and both mailed and telephone interview patient satisfaction surveys. The results showed that the typical patient served by VNA HouseCalls was a homebound woman in advanced old age with regular family contact and both physical and mental disorders. When asked, the typical patient indicated that without the program she would not have received the care that she needed.VNA HouseCalls helped in preventing functional decline and reducing hospitalization. It received high satisfaction ratings from both referral sources and patients. Study findings suggest that primary care in the home bears further examination for addressing community need and affecting positive patient outcomes for high risk older adults.

Home-Based Primary Care for Homebound Older Adults: Literature Review

“… 51) Most of the citizens living in the region where the HBPC pilot project was initiated hope the program to be continued. 50) …”

“…14,16,49) It is often said that homebound older adults might be difficult to use the primary healthcare services if there were no HBPC program in their hometown. 50) HBPC has also been known to be effective in reducing caregiver burden which occurs mostly during the process of unpaid care works by the family. 51) Most of the citizens living in the region where the HBPC pilot project was initiated hope the program to be continued.…”

“…51) Most of the citizens living in the region where the HBPC pilot project was initiated hope the program to be continued. 50) Home-Based Primary Care for Older Adults 69 HBPC should promote patients' health. In many studies, clinical effectiveness has been measured using the following outcome indicators: (1) mortality, (2) disability, (3) admission to long-term care facilities, (4) fall, (5) quality of life, and (6) caregiver burden.…”