Adelphi University College of Nursing and Public Health, 1 South Avenue, Garden City, New York 11530, United States.
Washington Hospital Center. 110 Irving Street, NW. Washington, DC 20010, United States.
Geriatr Nurs. 2020 Nov-Dec;41(6):962-969. doi: 10.1016/j.gerinurse.2020.07.001. Epub 2020 Jul 24.
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.
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.
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.
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.
随着能够为日益增多的美国家庭中身体不适的老年人提供上门护理服务的初级保健医生的短缺，护士从业者（NPs）越来越多地被用来满足对上门护理服务不断增长的需求，并且现在是提供上门访问的最大类型的初级保健医生。
本研究旨在系统地研究与 NP 上门访问相关的健康和医疗保健利用结果的现有证据。
系统地搜索了五个数据库（PubMed、EMBASE、护理与联合健康文献累积索引和 Cochrane 图书馆），以确定研究 NP 上门访问的研究。该搜索专注于发表于 2019 年 4 月之前的英语语言研究，并旨在描述与 NP 上门访问相关的结果。我们纳入了实验和观察性研究。使用 Kmet、Lee 和 Cook 工具进行质量评估，并进行定性总结。评估了 NP 上门访问对临床（功能状态、生活质量[QOL]）和医疗保健利用（住院、急诊部[ED]就诊）结果的影响。
结果/讨论：共确定了 566 条引文；符合纳入标准的有 7 项，纳入了综述。最常报告的结果是急诊部（ED）就诊和再入院。鉴于我们的搜索产生的文章数量有限，以及干预措施和结果测量的广泛差异，NP 上门访问与 3 项研究中的 2 项 ED 就诊减少和 4 项研究中的 2 项再入院减少相关。
评估 NP 上门访问相关结果的已发表研究数量有限且质量参差不齐。局限性包括样本量小，以及 NP 上门访问的持续时间和频率的差异。未来的研究应该使用大型和全国代表性的数据，采用更严格的研究设计，调查 NP 上门访问对老年人健康结果的独立影响。
