Department of Internal Medicine, Cleveland Clinic Community Care, USA; Healthcare Delivery and Implementation Science Center, Cleveland Clinic, USA; Center for Value-Based Care Research, Cleveland Clinic Community Care, USA; Department of Quantitative Health Sciences, Cleveland Clinic, USA.
Department of Internal Medicine, Cleveland Clinic Community Care, USA; Center for Value-Based Care Research, Cleveland Clinic Community Care, USA.
Healthc (Amst). 2021 Mar;9(1):100518. doi: 10.1016/j.hjdsi.2020.100518. Epub 2021 Jan 4.
Home visits after hospital discharge may reduce future healthcare utilization. We assessed the association of home visits by advanced practice registered nurses (APRN) and paramedics with healthcare utilization and mortality, and provider and patient experience.
We conducted a retrospective cohort study using convergent mixed methods in one health system including adult medical patients discharged to home from November 2017-September 2019. We assessed outcomes for home visit vs. matched comparison patients at 30, 90, and 180 days, including hospital admission, emergency department (ED) use, and death: Phase 1 (APRN or paramedic visits assigned by geographic location) and Phase 2 (APRN and paramedic visit teams assigned to patients). Patients declining home visits and those accepting were also compared. Semi-structured interviews were conducted with home visit patients and providers, primary care providers, and nurse care coordinators.
In Phase 1, the 101 home visit matched to 303 comparison patients showed no differences in readmissions, ED visits, or death at 30, 90, and 180 days. In Phase 2, 157 home visit matched to 471 comparison patients had fewer 30-day readmissions (19.1% vs. 28.7%, p 0.024) and no differences in other outcomes. Compared with patients declining home visits, patients accepting had lower odds of 30-day readmission. In 44 interviews, themes of Medication Understanding, Knowledge Gap after Discharge, Patient Medical Complexity, Social Context, and Patient Engagement/Need for Reassurance emerged.
Post-discharge home visits by APRNs and paramedics working together were associated with reduced 30-day readmissions. Identified themes could inform strategies to improve patient support.
出院后的家庭访视可能会减少未来的医疗保健利用。我们评估了高级实践注册护士（APRN）和护理人员的家庭访视与医疗保健利用和死亡率以及提供者和患者体验之间的关系。
我们使用一个医疗系统中的回顾性队列研究，使用收敛混合方法，纳入 2017 年 11 月至 2019 年 9 月期间出院回家的成年内科患者。我们评估了家庭访视与匹配对照患者在 30、90 和 180 天的结果，包括住院、急诊部（ED）使用和死亡：第 1 阶段（根据地理位置分配的 APRN 或护理人员访视）和第 2 阶段（分配给患者的 APRN 和护理人员访视团队）。还比较了拒绝家庭访视和接受家庭访视的患者。对家庭访视患者和提供者、初级保健提供者以及护士护理协调员进行了半结构化访谈。
在第 1 阶段，101 例家庭访视与 303 例对照患者相匹配，在 30、90 和 180 天，在再入院、急诊就诊或死亡方面没有差异。在第 2 阶段，157 例家庭访视与 471 例对照患者相比，30 天内再入院率较低（19.1%比 28.7%，p 0.024），其他结果无差异。与拒绝家庭访视的患者相比，接受家庭访视的患者 30 天内再入院的可能性较低。在 44 次访谈中，出现了药物理解、出院后知识差距、患者医疗复杂性、社会背景和患者参与/需要安慰等主题。
共同工作的 APRN 和护理人员进行的出院后家庭访视与降低 30 天内再入院率有关。确定的主题可以为改善患者支持提供策略。
