Rationale and design of a randomized controlled trial of home-based primary care versus usual care for high-risk homebound older adults

Reckrey, Jennifer; Brody, Abraham A.; McCormick, Elizabeth T.; DeCherrie, Linda V.; Zhu, Carolyn W.; Ritchie, Christine S.; Siu, Albert L.; Egorova, Natalia; Federman, Alex D.

doi:10.1016/j.cct.2018.03.011

Cited by 8 publications

(8 citation statements)

References 35 publications

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“…Our project was a qualitative arm of the "Home-based Primary Care for Homebound Seniors: A Randomized Controlled Trial" (HOME) study. 10 Because HBPC is a multidisciplinary, team-based model, we recruited practice leaders across multiple roles for interviews to obtain a range of perspectives and experiences. Interviews focused on experiences during the height of the NYC pandemic (March-June 2020) and were conducted from May to July 2020.…”

Section: Methodology Study Design Setting and Participantsmentioning

confidence: 99%

“At Home, with Care”: Lessons from New York City Home‐based Primary Care Practices Managing COVID‐19

Franzosa

Gorbenko

Brody

et al. 2020

J American Geriatrics Society

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Background/Objectives COVID‐19 required rapid innovation throughout the healthcare system. Home‐based primary care (HBPC) practices faced unique challenges maintaining services for medically complex older populations for whom they needed to adapt a traditionally hands‐on, model of care to accommodate restrictions on in‐person contact. Our aim was to determine strategies used by New York City (NYC)‐area HBPC practices to provide patient care during the first wave of the COVID‐19 pandemic with the goal of informing planning and preparation for home‐based practices nationwide. Design Cross‐sectional qualitative design using semi‐structured interviews. Setting HBPC practices in the NYC metro area during spring 2020. Participants HBPC leadership including clinical/medical directors, program managers, nurse practitioners/nursing coordinators, and social workers/social work coordinators (n = 13) at 6 NYC‐area practices. Measurements Semi‐structured interviews explored HBPC practices' COVID‐19 care delivery challenges, adaptations, and advice for providers. Interviewers probed patient care, end‐of‐life care, telehealth, community‐based services and staffing. Interviews were recorded and transcribed. Data were analyzed through a combined inductive and deductive thematic approach. Results Participants described care delivery and operational adaptations similar to those universally adopted across healthcare settings during COVID‐19, such as patient outreach and telehealth. HBPC‐specific adaptations included mental health services for patients experiencing depression and isolation, using multiple modalities of patient interactions to balance virtual care with necessary in‐person contact, strategies to maintain patient trust, and supporting team connection of staff through daily huddles and emotional support during the surge of deaths among long‐standing patients. Conclusion NYC‐area HBPC providers adapted care delivery and operations rapidly during the height of the COVID‐19 pandemic. Keeping older, medically complex patients safe in their homes required considerable flexibility, transparency, teamwork, and partnerships with outside providers. As the pandemic continues to surge around the United States, HBPC providers may apply these lessons and consider resources needed to prepare for future challenges.

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Section: Methodology Study Design Setting and Participantsmentioning

confidence: 99%

“At Home, with Care”: Lessons from New York City Home‐based Primary Care Practices Managing COVID‐19

Franzosa

Gorbenko

Brody

et al. 2020

J American Geriatrics Society

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“…20 We recruited patients who were currently enrolled in an ongoing randomized controlled trial of home-based primary care in New York City. 21 Patients were eligible for the larger ongoing trial if they met the Medicare definition of homebound, 22 were age sixty-five or older, had had one or more recent hospitalizations, had impairment in two or more activities of daily living (bathing, grooming, dressing, using the toilet, feeding, and transferring to bed or chair), and spoke English or Spanish. We then selected people who received eight or more hours of paid caregiver support per week and who had had consistent support from a particular paid caregiver for six months or more.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Beyond Functional Support: The Range Of Health-Related Tasks Performed In The Home By Paid Caregivers In New York

et al. 2019

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Paid caregivers (for example, home health aides and personal care attendants) are formally tasked with helping older adults with functional impairment meet their basic needs at home. This study used thirty semistructured interviews with dyads of patients or their proxies and their paid caregivers in New York City to understand the range of health-related tasks that paid caregivers perform in the home and determine whether these tasks are taught in the New York State Department of Health's curriculum. We found that patients, proxies, and paid caregivers all reported that paid caregivers performed a wide range of health-related tasks that were often not part of their formal training. Creating clear competencies for paid caregivers that reflect the full breadth of health-related tasks they may perform in the home could help maximize the positive impact of the paid caregiver workforce on the lives of patients living at home with functional impairment.

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“…HBPC was provided by an established program serving approximately 1200 homebound adults in Manhattan. Details of the program are provided elsewhere 12–14 . A HBPC nurse unaware of the patient's study participation called to assess their appropriateness for the program and determine urgency using a triage assessment, which considered life expectancy, clinical stability, home environment, social support needs, and the family's burden of care.…”

Section: Methodsmentioning

confidence: 99%

“…Study methods were reported previously. 12 Patients were recruited from Mount Sinai Health System primary care practices, the New Jewish Home subacute rehabilitation facility, and the Visiting Nurse Service of New York. Research assistants contacted the primary or supervising physician to determine homebound status and for assent for recruitment.…”

Section: Study Participants and Settingsmentioning

confidence: 99%

“…Details of the program are provided elsewhere. [12][13][14] A HBPC nurse unaware of the patient's study participation called to assess their appropriateness for the program and determine urgency using a triage assessment, which considered life expectancy, clinical stability, home environment, social support needs, and the family's burden of care. The nurse instructed all patients to continue office-based care until their first HBPC visit, since waiting times depended on the availability of the team serving the patient's neighborhood and could be as long as 8 months.…”

Section: Home-based Primary Care Interventionmentioning

confidence: 99%

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Outcomes of home‐based primary care for homebound older adults: A randomized clinical trial

Federman

Brody

Ritchie

et al. 2022

J American Geriatrics Society

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Background Homebound older adults are medically complex and often have difficulty accessing outpatient medical care. Home‐based primary care (HBPC) may improve care and outcomes for this population but data from randomized trials of HBPC in the United States are limited. Methods We conducted a randomized controlled trial of HBPC versus office‐based primary care for adults ages ≥65 years who reported ≥1 hospitalization in the prior 12 months and met the Medicare definition of homebound. HBPC was provided by teams consisting of a physician, nurse practitioner, nurse, and social worker. Data were collected at baseline, 6‐ and 12‐months. Outcomes were quality of life, symptoms, satisfaction with care, hospitalizations, and emergency department (ED) visits. Recruitment was terminated early because more deaths were observed for intervention patients. Results The study enrolled 229 patients, 65.4% of planned recruitment. The mean age was 82 (9.0) years and 72.3% had dementia. Of those assigned to HBPC, 34.2% never received it. Intervention patients had greater satisfaction with care than controls (2.26, 95% CI 1.46–3.06, p < 0.0001; effect size 0.74) and lower hospitalization rates (−17.9%, 95% CI −31.0% to −1.0%; p = 0.001; number needed to treat 6, 95% CI 3–100). There were no significant differences in quality of life (1.25, 95% CI −0.39–2.89, p = 0.13), symptom burden (−1.92, 95% CI −5.22–1.37, p = 0.25) or ED visits (1.2%, 95% CI −10.5%–12.4%; p = 0.87). There were 24 (21.1%) deaths among intervention patients and 12 (10.7%) among controls (p < 0.0001). Conclusion HBPC was associated with greater satisfaction with care and lower hospitalization rates but also more deaths compared to office‐based primary care. Additional research is needed to understand the nature of the higher death rate for HBPC patients, as well as to determine the effects of HBPC on quality of life and symptom burden given the trial's early termination.

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Rationale and design of a randomized controlled trial of home-based primary care versus usual care for high-risk homebound older adults

Cited by 8 publications

References 35 publications

“At Home, with Care”: Lessons from New York City Home‐based Primary Care Practices Managing COVID‐19

“At Home, with Care”: Lessons from New York City Home‐based Primary Care Practices Managing COVID‐19

Beyond Functional Support: The Range Of Health-Related Tasks Performed In The Home By Paid Caregivers In New York

Outcomes of home‐based primary care for homebound older adults: A randomized clinical trial

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