Improving outcomes and lowering costs by applying advanced models of in-home care

Abstract

With advances in monitoring and telemedicine, the complexity of care administered in the home to properly selected patients can approach that delivered in the hospital. The challenges include making sure that qualified personnel regularly visit the patient at home, both individually and in teams; information is accurately communicated among the caregiver teams across venues and over time; and patients understand the information communicated to them by providers. Despite these challenges, the benefits of treating chronically or terminally ill patients at home are significant. Among the most important are improved patient satisfaction and reduced cost. Numerous studies have shown that most patients prefer to spend their convalescence or their last days at home. The financial benefits of enabling patients to recover or to die at home are significant.

Effects of Home‐Based Primary Care on Medicare Costs in High‐Risk Elders

“…To the knowledge of the authors, this is the first well‐designed, case–control study of HBPC for frail elders in the Medicare FFS arena. Potential confounders present in previous before‐and‐after comparison studies were adjusted for by providing a methodologically robust external control group . The large Medicare database and covariate adjustments addressed statistical challenges of selection bias and regression‐to‐the mean effects common in population‐based studies.…”

“…Ethical barriers to randomized controlled studies and difficulty identifying an adequate control group has limited research on HBPC programs. Prior observational research found that, over a 4‐year period, a posthospital house call program had aggregate costs that were 38% lower than for the 6 months before enrollment . Another study showed that individuals in an HBPC program were less likely to enter a hospital and had lower rates of ED and specialty care visits .…”

“…Potential confounders present in previous before-and-after comparison studies were adjusted for by providing a methodologically robust external control group. 17,24,25 The large Medicare database and covariate adjustments addressed statistical challenges of selection bias and regression-to-the mean effects common in population-based studies. This methodology supports an accurate estimate of the model's effects on Medicare costs and mortality, apart from other factors.…”

Evaluation of home respiratory therapy delivered to patients in the Ministry of Health’s Home Medical Program (HMP) and administered through the Madinah HMP Center, Kingdom of Saudi Arabia, 2013

“…The various benefits of incorporating HHC in the health system are known worldwide [6]. The services provided through HHC programs are different from country to country, but most programs are community-based, staffed mainly by professional nurses, and regulated by standard guidelines, which reflect the standard of care for all home health agency interactions [4].…”

The Invisible Homebound: Setting Quality-Of-Care Standards For Home-Based Primary And Palliative Care

“…3,4 Home-based medical care, which encompasses both primary and palliative care, provides a mechanism for such patients to obtain ongoing doi: 10 care in the community setting. 5 In home-based primary care, patients ideally receive comprehensive longitudinal primary medical care at home from an interprofessional team of physicians, nurse practitioners, or both, together with nurses, social workers, and skilled therapists. In some cases, all team members are employees of a given practice.…”