Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use
Health Aff (Millwood). 2017 Mar 1;36(3):425-432. [Pubmed Abstract]
Ruiz S, Snyder LP, Rotondo C, Cross-Barnet C, Colligan EM, Giuriceo K
While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or…
Impact of CHWs on Elderly Patients’ Advance Care Planning and Health Care Utilization: Moving the Dial
Litzelman DK, Inui TS, Griffin WJ, Perkins A, Cottingham AH, Schmitt-Wendholt KM, Ivy SS
Med Care. 2016 Nov 21. [Pubmed Abstract]
Advance care planning (ACP) is recommended for all persons to ensure that the care they receive aligns with their values and preferences.
To evaluate an ACP intervention developed to better meet the needs and priorities of persons with chronic diseases, including mild cognitive impairment.
A year-long, pre-post intervention using lay community health workers [care coordinator assistants (CCAs)] trained to conduct and document ACP conversations with patients during home health visits with pre-post evaluation.
The 818 patients were 74.2 years old (mean); 78% women; 51% African American; 43% white.
Documentation of ACP conversation in electronic health record fields and health care utilization outcomes.
In this target population ACP documentation rose from 3.4% (pre-CCA…
JAMA Intern Med. 2015 Jan 1;175(1):109-17. [Pubmed Abstract]
Community Health Worker Home Visits for Adults With Uncontrolled Asthma: The HomeBASE Trial Randomized Clinical Trial
Krieger J, Song L, Philby M
Asthma is often poorly controlled. Home visitation by community health workers (CHWs) to improve control among adults has not been adequately evaluated.
To test the hypothesis that CHW home visits for adults with uncontrolled asthma improve outcomes relative to usual care.
Design, Setting, and Participants
Randomized parallel group study with 1-year follow-up, conducted 2008 through 2011 at homes of low-income adults aged 18 to 65 years with uncontrolled asthma living in King County, Washington.
The CHWs provided a mean of 4.9 home visits during a 1-year period to assess asthma control, self-management, and home environment and to support asthma self-management practices.
Main Outcomes and Measures