Article Figures & Data
Tables
FEATURE MODEL 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
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Maximize independence and function
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Reduce emergency department, hospital, and long-term care admissions
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Enhance patient safety and quality of life
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Link with supportive home-care services14,15
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Assess needs and develop care plan (to be implemented by office-based primary care provider or specialist)
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Serve as a substitute for acute hospital care
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Reduce iatrogenic events (nosocomial infections, functional decline, pressure sores, delirium, falls, etc)16
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Reduce overall costs
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Prevent adverse outcomes after discharge from hospital (improve coordination and continuity of care, reduce readmissions)19
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Reduce overall costs
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Support independent living
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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% -
ED—emergency department, HBPC—home-based primary care, LTC—long-term care, VA—Veterans Affairs.
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