Ten Things Every Geriatrician Should Know About House Calls

Abstract

Home‐based primary care (HBPC) is experiencing a reemergence to meet the needs of homebound older adults. This brief review based on existing literature and expert opinion discusses 10 key facts about HBPC that every geriatrician should know: (1) the team‐based nature of HBPC is key to its success; (2) preparations and after‐hour access for house calls are required; (3) home safety for the clinician and patient must be considered; (4) being homebound is an independent mortality risk factor with a high symptom burden; (5) home care medicine presents unique benefits and challenges; (6) a systems‐based approach to care is essential; (7) HBPC is a sustainable model within value‐based care proven by the Department of Veterans Affairs and the Independence at Home Medicare Demonstration Project; (8) HBPC has an educational mission; (9) national organizations for HBPC include American Academy of Home Care Medicine and Home Centered Care Institute; and (10) practicing HBPC is a privilege. HBPC is a dynamic and unique practice model that will continue to grow in the future. J Am Geriatr Soc 67:139–144, 2019.

Telehealth in Home‐Based Primary Care: Factors and Challenges Associated With Integration Into Veteran Care

“…Moreover, the Centers for Medicare and Medicaid Services' (CMS’) Independence at Home (IAH) demonstration, similar in design to the VA's HBPC model, has shown reduced emergency department visits, preventable hospital admissions, unplanned hospital readmissions, and lower annual Medicare expenditures per beneficiary . These IAH results, confirming VA's experience, demonstrate HBPC as a model of value‐based care for older adults with high needs, who are at risk for receiving healthcare at a disproportionately high cost …”

“…11 These IAH results, confirming VA's experience, demonstrate HBPC as a model of value-based care for older adults with high needs, who are at risk for receiving healthcare at a disproportionately high cost. 12,13 Although this previous research has addressed important questions about the impact of HBPC, inadequate attention has been given to understanding the structural attributes and operational processes that contribute to the success of HBPC. Strategically, telehealth is one of the VA's transformational initiatives aimed at expanding access and reach of high-quality, patient-centered healthcare, which similarly drives telehealth use outside the VA. 3,14 Telehealth services cover a broad range of electronic services available in the home that can be generally divided into three categories: (a) electronic monitoring with messaging technology, referred to as home telehealth (HT) without video; (b) video via telehealth devices, including tablets, called video telehealth; and (c) store and forward (Table 1).…”

Emergency Department Visits Before, After and During Integrated Home Care: A Time Series Analyses in Italy

“…22 More than a third of all ED visits in our sample resulted in a discharge to the patient's home, suggesting that, in some cases, the IHC team may have used an ED visit for diagnostic purposes, such as to conduct immediate imaging and/or invasive procedures. This seems especially plausible when only after-hours or on-call services are available, when the necessary procedures cannot be performed at the patient's home, 23 or after a home care nursing visit reveals deterioration that deserves deeper clinical evaluation. 11 Indeed, in our sample about 6% of ED visits were used for routine healthcare services.…”

The effect of home visits on healthcare resource utilisation

“…2,5 Home-based care has been on a constant rise. [6][7][8] For example, the Integrated Home Healthcare Program of the Taiwanese National Health Insurance (NHI) has been in practice since February 2016. The long-term purpose is to improve accessibility, and therefore, to decrease outpatient and emergency room visits and hospitalisation.…”