Back to the future: home-based primary care for older homebound Canadians: Part 1: where we are now

Nathan Stall; Mark Nowaczynski; Samir K. Sinha

Article Figures & Data

Tables

View popup

Table 1

Distinguishing home-based primary care from other home-care models

FEATURE	MODEL
FEATURE	HOME-BASED PRIMARY CARE	OUTREACH HOME VISITS	HOSPITAL-AT-HOME	TRANSITIONAL HOME CARE	SKILLED HOME CARE
Functional model	Ongoing comprehensive primary care in the home¹⁴	Home-based multidimensional geriatric assessments	Acute medical care in the home¹⁶	Medical care after hospital discharge	Targeted nursing, allied health, and social care services
Care focus	Complex and interrelated chronic disease management and social care issues	Needs assessments	Acute illness or chronic disease exacerbation	Often disease specific (eg, heart failure¹⁷ or chronic obstructive pulmonary disease¹⁸)	Remediable conditions¹⁴ and supporting independent living
Time course	Ongoing	Consultation with possible limited follow-up	Time-limited to the end of an acute episode	Time-limited to a designated period after discharge	Time-limited to ongoing
Personnel	Primary care provider–led interprofessional teams	Varied, but typically nursing and allied health professionals	General practitioners, specialists, nurses, and allied health professionals	General practitioners, specialists, nurses, and allied health professionals	Nursing and allied health professionals only
Goals of care	Improve access to primary care Maximize independence and function Reduce emergency department, hospital, and long-term care admissions Enhance patient safety and quality of life Link with supportive home-care services^14,15	Assess needs and develop care plan (to be implemented by office-based primary care provider or specialist)	Serve as a substitute for acute hospital care Reduce iatrogenic events (nosocomial infections, functional decline, pressure sores, delirium, falls, etc)¹⁶ Reduce overall costs	Prevent adverse outcomes after discharge from hospital (improve coordination and continuity of care, reduce readmissions)¹⁹ Reduce overall costs	Support independent living

View popup

Table 2

Emerging evidence supporting HBPC

STUDY	DESIGN	SAMPLE SIZE (INTERVENTION/CONTROL)	SETTING	DURATION	ED VISITS	HOSPITAL ADMISSIONS	LTC ADMISSIONS
Beck et al, 2009²⁶	Observational	468/0	Marion County, Indianapolis	7 y	Decreased 15%	Decreased 8%	Not measured
Chang et al, 2008²⁸	Retrospective review	183/0	Washington VA Medical Center	2 y	No significant difference	Decreased 44%	Not measured
Cooper et al, 2007²⁹	Retrospective review	20 783/0	All veterans in the US HBPC program	1 y	Not measured	Decreased 27%	Not measured
De Jonge and Taler, 2002¹³	Observational	480/0	Washington Hospital Center	3 y	Not measured	Decreased 30%	Decreased 10%
Hughes et al, 2000²⁷	Multisite randomized controlled trial	981/985	16 US VA medical centres	4 y	Not measured	No significant difference (but decreased 22% in severely disabled)	Not measured
North et al, 2008¹⁵	Observational	104/0	Denver VA Medical Center	1 y	Decreased 48%	Decreased 84%	Not measured
Rosenberg, 2012³⁰	Observational	248/0	Victoria, BC	1 y	Decreased 20%	Decreased 40%	Not measured
Wajnberg et al, 2010²	Retrospective review	179/0	Bronx, NY	22 mo	Not measured	Decreased 23%	Decreased 20%