The outcomes of nurse practitioner (NP)-Provided home visits: A systematic review.

BACKGROUND: With the shortage of primary care providers to provide home-based care to the growing number of homebound older adults in the U.S. Nurse Practitioners (NPs) are increasingly utilized to meet the growing demand for home-based care and are now the largest type of primary care providers delivering home-visits. PURPOSE: The purpose of this study was to systematically examine the current state of the evidence on health and healthcare utilization outcomes associated with NP-home visits. METHOD: Five Databases (PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library) were systematically searched to identify studies examining NP-home visits. The search focused on English language studies that were published before April 2019 and sought to describe the outcomes associated with NP-home visits. We included experimental and observational studies.  Quality appraisal was performed with the Kmet, Lee & Cook tool, and results summarized qualitatively. The impact of NP-home visits on clinical (functional status, quality of life [QOL]), and healthcare utilization (hospitalization, Emergency department(ED) visits) outcomes was evaluated. RESULTS/DISCUSSION: A total of 566 citations were identified; 7 met eligibility criteria and were included in the review. The most commonly reported outcomes were emergency department (ED) visits and readmissions. Given the limited number of articles generated by our search and wide variation in intervention and outcomes measures. NP-home visits were associated with reductions in ED visits in 2 out of 3 studies and with reduction in readmissions in 2 out of 4 studies. CONCLUSION: Published studies evaluating the outcomes associated with NP-home visits are limited and of mixed quality. Limitations include small sample size, and variation in duration and frequency of NP-home visits. Future studies should investigate the independent effect of NP-home visits on the health outcomes of older adults using large and nationally representative data with more rigorous study design.

Home Health Agency Factors Associated With Acute Care Hospitalization and Emergency Department Use.

We linked the Medicare Provider Utilization and Payment Data for Home Health and the Home Health Compare data for the year 2016 to identify home healthcare agency (HHA) characteristics associated with acute care hospitalization (ACH) or emergency department (ED) use. The study cohort consisted of 9,800 HHAs. Beta regression was used to examine the association between average age, race/ethnic composition, number of skilled nursing visits, number of therapy visits, percentage of dual eligible patients, HHA ownership, HHA location, Medicare tenure, proportion of patients with a diagnosis of schizophrenia, stroke, diabetes, depression, chronic obstructive pulmonary disease (COPD), heart failure, cancer and Alzheimer disease, and ACH or ED use. After controlling for HHA-level characteristics, variations in HHAs' ACH and unplanned ED visits were found. For-profit HHAs were significantly less likely to have patients with ACH. (Odds ratio = -0.05, p = 0.020), HHAs in the Midwest, South, and West had lower odds of ACH. HHAs that serve more than 50% Black patients had significantly decreased odds (ß = -0.16, p < 0.001) of ACH. A 1-unit increase in the proportion of patients with a diagnosis of schizophrenia, COPD, stroke, heart failure, and Alzheimer disease was associated with increased odds of hospitalization. For each unit increase in the number of skilled nursing visits, the odds of ACH increased by 0.02 (p = 0.001). For-profit and nonprofit HHAs had a significant decrease in the odds of unplanned ED visits (p < 0.05). An increase in the proportion of patients with COPD was associated with increased odds of unplanned ED visits (p < 0.001). HHA characteristics are associated with hospitalization and ED use without hospitalization. These characteristics point to variation in quality of care measured by ACH and ED use.