Healthcare utilization and patient and provider experience with a home visit program for patients discharged from the hospital at high risk for readmission

Abstract

Background: Home visits after hospital discharge may reduce future healthcare utilization. We assessed the association of home visits by advanced practice registered nurses (APRN) and paramedics with healthcare utilization and mortality, and provider and patient experience.

Methods: We conducted a retrospective cohort study using convergent mixed methods in one health system including adult medical patients discharged to home from November 2017-September 2019. We assessed outcomes for home visit vs. matched comparison patients at 30, 90, and 180 days, including hospital admission, emergency department (ED) use, and death: Phase 1 (APRN or paramedic visits assigned by geographic location) and Phase 2 (APRN and paramedic visit teams assigned to patients). Patients declining home visits and those accepting were also compared. Semi-structured interviews were conducted with home visit patients and providers, primary care providers, and nurse care coordinators.

Results: In Phase 1, the 101 home visit matched to 303 comparison patients showed no differences in readmissions, ED visits, or death at 30, 90, and 180 days. In Phase 2, 157 home visit matched to 471 comparison patients had fewer 30-day readmissions (19.1% vs. 28.7%, p 0.024) and no differences in other outcomes. Compared with patients declining home visits, patients accepting had lower odds of 30-day readmission. In 44 interviews, themes of Medication Understanding, Knowledge Gap after Discharge, Patient Medical Complexity, Social Context, and Patient Engagement/Need for Reassurance emerged.

Conclusion: Post-discharge home visits by APRNs and paramedics working together were associated with reduced 30-day readmissions. Identified themes could inform strategies to improve patient support.

Keywords: Home care services; Hospital readmission; Primary health care.