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Homebound older adults may receive suboptimal care during hospitalizations and transitions home or to postacute settings. This 2-year study describes a nurse practitioner (NP)-led transitional care program embedded within an existing home-based primary care (HBPC) program. The transitional care pilot program was designed to improve coordination and continuity of care, reduce readmissions, garner positive provider feedback, and demonstrate financial benefits through shorter length of stay, lower cost of inpatient stay, and better documentation of patient complexity. A detailed mixed-methods evaluation was conducted to characterize the hospitalized homebound population and investigate provider feedback and program feasibility, effectiveness, and costs. Length of stay (LOS), case-mix index, and admission-related financial costs were compared before and after the intervention using a pre-post design. Structured focus groups were conducted with inpatient and primary care providers to collect feedback on the usefulness of and satisfaction with the program. The program improved communication between home-based primary care providers and inpatient providers of all disciplines and facilitated the timely and accurate transfer of critical patient information. The intervention failed to decrease hospital LOS and readmission rate significantly for people who were hospitalized. The financial implications were reassuring, although future studies are necessary. This model of a NP-led program may be feasible for enhancing inpatient management and transitional care for older adults in HBPC programs and should be considered to augment the HBPC care model.

Rationale: Glucagon-like peptide-1 receptor (GLP-1R) agonists are approved to treat type 2 diabetes mellitus and obesity. GLP-1R agonists reduce airway inflammation and hyperresponsiveness in preclinical models. Objectives: To compare rates of asthma exacerbations and symptoms between type 2 diabetic adults with asthma prescribed GLP-1R agonists and those prescribed sodium-glucose cotransporter-2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, sulfonylureas or basal insulin for diabetes treatment intensification. Methods: Electronic health records-based new-user, active comparator, retrospective cohort study of patients with type 2 diabetes and asthma newly prescribed GLP-1R agonists or comparator drugs, January 2000-March 2018. Primary outcome was asthma exacerbations; secondary outcome was encounters for asthma symptoms. Propensity scores were calculated for GLP-1R agonist and non-GLP-1R agonist use. Zero-inflated Poisson regression models included adjustment for multiple covariates. Measurements and Main Results: Patients initiating GLP-1R agonists (n=448), SGLT-2 inhibitors (n=112), DPP-4 inhibitors (n=435), sulfonylureas (n=2,253) or basal insulin (n=2,692), were identified. At six months, asthma exacerbation counts were lower in persons initiating GLP-1R agonists (reference) compared to SGLT-2 inhibitors (incidence rate ratio [IRR], 2.98 [95% CI, 1.30 to 6.80]), DPP-4 inhibitors (IRR, 2.45 [95% CI, 1.54 to 3.89]), sulfonylureas (IRR, 1.83 [95% CI, 1.20 to 2.77]) and basal insulin (IRR, 2.58 [95% CI, 1.72 to 3.88]). Encounters for asthma symptoms were also lower among GLP-1R agonist users. Conclusions: Adult asthmatics prescribed GLP-1R agonists for type 2 diabetes had lower counts of asthma exacerbations compared to other drugs initiated for treatment intensification. GLP-1R agonists may represent a novel treatment for asthma associated with metabolic dysfunction.