Reduced emergency room and hospital utilization in persons with multiple chronic conditions and disability receiving home-based primary care.
Disabil Health J
; 10(2): 326-333, 2017 04.
Article
em En
| MEDLINE
| ID: mdl-27793527
ABSTRACT
BACKGROUND:
Persons with multiple chronic conditions and disability face access barriers to office-based primary care and have very high rates of emergency department (ED) use and hospital admissions. Home-based primary care (HBPC) has been proposed as a way to improve disease management and prevent health crises.HYPOTHESIS:
Enrollment of patients with disability and multiple chronic conditions in a HBPC program is associated with a subsequent decrease in ED visits and hospital admissions.METHODS:
We abstracted electronic medical record (EMR) data among patients receiving HBPC and compared rates per 1000 patient days for ED visits, admissions, 30-day readmissions, and inpatient days for up to three years before and after enrollment.RESULTS:
Of 250 patients receiving HBPC, 153 had admission data recorded in our EMR prior to enrollment. One year after HBPC enrollment, the rate of admissions dropped by 5.2 (95% confidence interval 4.3, 6.0), 30-day readmissions by 1.8 (1.3, 2.2) and inpatient days by 54.6 (52.3, 56.9) per 1000 patient-days. Three years post-enrollment, rates remained below baseline by 2.2 (1.3, 3.1) for admissions, 0.5 (0.04, 1.0) for 30-day readmissions and 32.2 (29.8, 34.7) for inpatient days. Among 91 patients with pre-enrollment ED data, the rate of ED visits also dropped at one and three years by 5.5 (4.6, 6.4) and 2.7 (1.7, 3.7), respectively.CONCLUSION:
Provision of HBPC for persons with multiple chronic conditions and disability is associated with a persistent reduction in ED and hospital use.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
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Pessoas com Deficiência
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Serviço Hospitalar de Emergência
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Múltiplas Afecções Crônicas
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Acessibilidade aos Serviços de Saúde
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Serviços de Assistência Domiciliar
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Hospitais
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article