Home-Based Primary Care: A Promising Approach Allan S. Brett, MD reviewing De Jonge KE et al. J Am Geriatr Soc 2014 Oct. Edes T et al. J Am Geriatr Soc 2014 Oct. In frail elders, HBPC lowered hospital admissions and overall costs. Home-based primary care (HBPC) refers to interdisciplinary provision of extensive medical and social services in the home. HBPC is longitudinal and comprehensive, unlike the time-limited and piecemeal “home-health” visits by nurses or physical therapists that sometimes follow hospitalizations or house calls by single physicians. In two reports, researchers describe healthcare-use outcomes with HBPC. An HBPC program in Washington, DC, was implemented by a team of physicians, nurses, social workers, and mental health providers; the same physicians who saw patients in their homes cared for them if they were hospitalized. Round-the-clock on-call telephone coverage was provided. In a case-control analysis, 722 chronically ill HBPC patients (mean age, 84) were compared with 2161 well-matched controls. During an average follow-up of 2 years, HBPC patients had 9% fewer hospitalizations, 10% fewer emergency department visits, 27% fewer skilled nursing facility days, and 23% fewer specialist visits, compared with controls. Cost savings from fewer healthcare encounters more than offset the additional cost of comprehensive home care and generalist physician services, resulting in 17% lower overall Medicare costs for HBPC participants. Mortality was similar in the two groups. In another report, researchers compared observed and projected use for 9425 chronically ill participants (mean age, 78) in a U.S. Veterans Affairs HBPC program. During the year after enrollment, hospital admissions and hospital days were lower than projected by 26% and 37%, respectively. Overall costs were 12% lower than projected. Interviewed patients reported very high levels of satisfaction. Comment In these studies, comprehensive home care by truly interdisciplinary teams lowered hospital admissions and overall costs; in both studies, cost savings were concentrated in the frailest and sickest patients. Although clinical outcomes were not tracked in these studies, Id bet that quality of care was maintained or enhanced in these programs. Editor Disclosures at Time of Publication • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose CLOSE Citation(s): 1. De Jonge KE et al. Effects of home-based primary care on Medicare costs in high-risk elders. J Am Geriatr Soc 2014 Oct; 62:1825. (dx.doi.org/10.1111/jgs.12974) PubMed abstract (Free) 2. Edes T et al. Better access, quality, and cost for clinically complex veterans with home-based primary care. J Am Geriatr Soc 2014 Oct; 62:1954. (onlinelibrary.wiley/doi/10.1111/jgs.13030/abstract) PubMed abstract (Free) - See more at: jwatch.org/na36208/2014/11/13/home-based-primary-care-promising-approach?query=etoc_jwgenmed#sthash.FkdYrRNL.dpuf
Posted on: Fri, 14 Nov 2014 13:02:32 +0000
Trending Topics
Recently Viewed Topics
© 2015