Study: House Calls Cut Readmissions, Unnecessary ER Use

Nurse practitioners are program’s linchpin

In 2009, HealthCare Partners Affiliates Medical Group, based in Southern California, launched House Calls, an in-home program that provides, coordinates, and manages care primarily for recently discharged high-risk, frail, and psychosocially compromised patients. The program’s aim is to reduce preventable emergency department visits and hospital readmissions.

After being involved with the program for three months, patients were admitted to the hospital less often — and per-month utilization and spending continued to decrease, even six months after patients left the program, according to an article posted on the FierceHealthcareManagement website. The findings were published in Health Affairs.

Nurse practitioners, social workers, and medical assistants work on physician-led care teams to care for 7,925 patients, most of whom have multiple comorbidities, such as hypertension (81%), peripheral vascular disorders (60%), renal failure (59%), cardiac arrhythmias (47%), uncomplicated diabetes (43%), chronic obstructive pulmonary disease (42%), congestive heart failure (41%), and depression (40%).

Nurse practitioners are the linchpin in the program, where they develop patients’ care plans while monitoring them and communicating updates to primary care physicians. Social workers assess patients in their home environments, where they can identify potential issues — such as fall risks, medication organization, social isolation, and financial concerns — and provide food and nutrition coaching.

The California program isn’t the only one that has had success with house calls. Remedy Urgent Care, based in Austin, Texas, sends two clinicians in a van with medical supplies to treat sick children and adults in their homes. The urgent care business commits to arriving at the patient’s home within 90 minutes and allows patients to avoid a trip to the doctor’s office or emergency room, FiercePracticeManagement previously reported.

House calls have their down side, however. While his patients were able to schedule appointments online and he had access to their patient records, Jay Parkinson, MD, told the website that he was unable to see more than eight patients each day because of the need to travel to each patient's home and always be stocked with the right supplies.

Sources: FiercePracticeManagement; January 26, 2016; and Health Affairs; January 2016.