Shiyuan Yin

Shiyuan Yin is the MVC Research Associate.

Innovative home visit programs are exploring affordable ways to provide quality, rapid care at home while maintaining a tight connection to patients’ primary care providers. A home visit program based in California, DASH (Doctors Assisting Seniors at Home), works to better provide care to patients outside of the emergency department (ED). Patients aged 18 and above who might be too weak to commute to an ED and wait for services now have the option to give DASH a call (DASH, n. d.). Upon calling, skilled nurses and health providers will arrive where the patient resides within an hour. For those residents who live in low-income housing or receive Medi-Cal, this conveniently helpful service is free.

As the population ages it becomes increasingly important, yet challenging, to provide quality of care for older adults. Numerous studies have shown physician-provided home care is effective in saving costs and reducing unnecessary admissions, but little is known regarding whether home-based care delivered by practice-extender teams—such as teams led by registered nurses or lay health workers—can achieve similar results. A study led by researchers from the University of Chicago and Centers for Medicare and Medicare Services examines the effectiveness of five home visit models for older adults and finds compelling results. While DASH is one of the models studied, four other home visit models are also mentioned:

  1. ABC (Aging Brain Care) which focuses on providing care for those with depression or dementia;
  2. CAPABLE (Community Aging in Place, Advancing Better Living for Elders) which offers visits not only from occupational therapists and nurses but also handymen to help maintain seniors living at home;
  3. Stroke Mobile, a mobile stroke unit complete with CT scanner that allows for rapid on the spot treatment of stroke victims; and
  4. AIM (Advanced Illness Management) which aims to improve quality of care and care coordination in those with advanced illness.

Research findings suggest that four of the five models are associated with reduced total Medicare expenditures or utilization. Further analyses show cost savings for CAPABLE and AIM, significant reduction in ED visits for DASH, and decreased hospitalizations for Stroke Mobile, DASH, and AIM (Ruiz et al., 2017). After DASH enrolled 2,000 people in the Santa Barbara area, there was a 38% drop in visits to the emergency room and a 41% reduction in hospitalizations (DASH, n. d.). Home visit programs also have additional advantages, allowing hospitals to “reach high-risk, high-needs patients before a change in condition necessitates a higher level of care and mitigate access barriers such as lack of transportation or limited mobility” (Ruiz et al., 2017). Due to the effort in care coordination and patient/consumer engagement, these five home visit models show improved quality of care despite differences in design and diversity in patient population. Although it is important for hospitals to develop a model that fits their own conditions, the value of having practice extenders provide home visits is significant and translatable to health providers in other regions.

Furthermore, the overall improvement in quality of care for each model is summarized in the table below:

Source: Ruiz et al. (2017) analysis of information gathered by NORC from site visits, interviews, and program materials, as of December 2015, page 431.

 

References:

DASH. (n. d.). Retrieved September 28, 2017 from DASH: http://www.dashsb.com/

Ruiz, S., Snyder, L. P., Rotondo, C., Cross-Barnet, C., Colligan, E. M., & Giuriceo, K. (2017). Innovative home visit models associated with reductions in costs, hospitalizations, and emergency department use. Health Affairs, 36(3), 425–432. https://doi.org/10.1377/hlthaff.2016.1305

Potthoff, G. (2014, December 27). Santa Barbara seniors find peace of mind with DASH medical care program. Noozhawk. Retrieved from: https://www.noozhawk.com/article/santa_barbara_seniors_peace_of_mind_dash_medical_care_program_20141227%20