Reduced emergency room and hospital utilization in persons with multiple chronic conditions and disability receiving home-based primary care

• Published in: Disability and health journal Vol. 10; no. 2; pp. 326 - 333
• Main Authors: Schamess, Andrew, MD, Kretovics, Matthew, MPH, Barnes, Kelli, PharmD, BCACP, Beatty, Stuart, PharmD, BCACP, CDE, Bose-Brill, Seuli, MD, Tayal, Neeraj, MD
• Format: Journal Article
• Language: English
• Published: United States 01.04.2017
• Subjects: Adult; Aged; Disabled Persons; Emergency Service, Hospital - utilization; Female; Health Services Accessibility; Home Care Services; Hospitalization; Hospitals - utilization; Humans; Internal Medicine; Male; Middle Aged; Multiple Chronic Conditions - therapy; Patient Acceptance of Health Care; Primary Health Care; electronic medical record; Veteran’s Affairs Medical Centers; Emergency Department; Standard Deviation; LPN; HBPC; Ohio State University Wexner Medical Center; Disability; SD; Adults with Chronic Health Care Needs; OSUWMC; Patient-Centered Medical Home; Licensed Practical Nurse; ED; Multiple Chronic Conditions; Health Service Utilization; ACHCN; OSU Healthy at Home; CI; ACS-6; VAMC; American Community Survey six question disability assessment; EMR; PCMH; Home-Based Primary Care; Hospital Readmission; OSUHH; Confidence Interval; Primary Care Provider; Registered Nurse; PCP; RN; Health service utilization; Home-based primary care; Hospital readmission; Multiple chronic conditions
• ISSN: 1936-6574; 1876-7583
• DOI: 10.1016/j.dhjo.2016.10.004

Abstract Background Persons with multiple chronic conditions and disability face access barriers to office-based primary care and have very high rates of emergency department (ED) use and hospital admissions. Home-based primary care (HBPC) has been proposed as a way to improve disease management and prevent health crises. Hypothesis Enrollment of patients with disability and multiple chronic conditions in a HBPC program is associated with a subsequent decrease in ED visits and hospital admissions. Methods We abstracted electronic medical record (EMR) data among patients receiving HBPC and compared rates per 1000 patient days for ED visits, admissions, 30-day readmissions, and inpatient days for up to three years before and after enrollment. Results Of 250 patients receiving HBPC, 153 had admission data recorded in our EMR prior to enrollment. One year after HBPC enrollment, the rate of admissions dropped by 5.2 (95% confidence interval 4.3, 6.0), 30-day readmissions by 1.8 (1.3, 2.2) and inpatient days by 54.6 (52.3, 56.9) per 1000 patient-days. Three years post-enrollment, rates remained below baseline by 2.2 (1.3, 3.1) for admissions, 0.5 (0.04, 1.0) for 30-day readmissions and 32.2 (29.8, 34.7) for inpatient days. Among 91 patients with pre-enrollment ED data, the rate of ED visits also dropped at one and three years by 5.5 (4.6, 6.4) and 2.7 (1.7, 3.7), respectively. Conclusion Provision of HBPC for persons with multiple chronic conditions and disability is associated with a persistent reduction in ED and hospital use.