Impact of a Home-Based Primary Care Program in an Urban Veterans Affairs Medical Center
published online 22 December 2008.
Objectives
Describe how an interdisciplinary home-based primary care program (HBPC) affected hospital and emergency department (ED) use in an urban Veterans Affairs medical center.
Design
A retrospective review.
Setting
HBPC of the Washington, DC, Veterans Affairs Medical Center (VAMC-DC).
Participants
All HBPC patients enrolled for at least 6 months during the period of January 1, 2001 through December 31, 2002.
Measurements
Baseline demographic variables (such as age, gender, race, living arrangement, community services used), major medical diagnoses, functional measures (MMSE, ADL, IADL, Braden), advance directives, episodes of ED, and hospital use for the 6-month period before and after HBPC enrollment from the VAMC-DC and discharge status (obtained from electronic medical records).
Results
A total of 183 patients were enrolled in HBPC for at least 6 months during the 24-month study period. Ninety-five percent were male with a mean age of 73.6 years (range 36 to 95). Most were African American (71%) and lived with a caregiver (65%). The average number of comorbidities was 6 per patient. At the end of the 2-year study period, 45% remained active in HBPC and 17% had died. Using paired score analysis t tests, patients enrolled in HBPC for 6 months had 43.7% fewer hospital admissions (P = .001) and spent 49.9% fewer days in the hospital (P = .001). The 18.5% reduction in ED visits was not statistically significant (P = .2632).
Conclusions
Use of HBPC for 6 months for frail chronically ill patients in an urban VAMC may be associated with fewer hospital admissions resulting in reduced total hospital days, but no significant change in ED use.
aVeterans Affairs Medical Center, Division of Geriatric and Extended Care, Washington, DC
bVeterans Affairs Medical Center, War-Related Illness and Injury Study Center, Washington, DC
cThe Catholic University of America, Washington, DC
dGeorge Washington University Medical Center, Washington, DC
Address correspondence to Christine Chang, MD, Mount Sinai Medical Center, One Gustave L. Levy Place, Annenberg Building, Box 1070, Room 10-20, New York, NY 10029-6574
No conflict of interest. The authors have no relevant financial information to disclose, but acknowledge the following: Dr. Chang's work was conducted during her employment as Medical Director of the Home-Based Primary Care Program at the Washington, DC, Veterans Affairs Medical Center. She is currently a member of the Department of Geriatrics at the Mount Sinai Medical Center in Manhattan. Susan Jackson continues to be employed as a nurse at the Washington, DC, Veterans Affairs Medical Center where she currently is the Program Director for Care Coordination and Home Telehealth.
ABSTRACT