Home-Based Primary Care Interventions [Retrospectively Entered]

Project Summary Title and Description

Home-Based Primary Care Interventions [Retrospectively Entered]
Objective. To assess the available evidence about home-based primary care (HBPC) interventions for adults with serious or disabling chronic conditions. Data sources. Articles from January 1998 through May 2015 were identified using Ovid MEDLINE, CINAHL, Clinical Trials.gov, Cochrane Database of Systematic Reviews, reference lists, and gray literature databases. Review methods. We included randomized controlled trials (RCTs) and observational studies of HBPC, including home visits by a primary care provider, longitudinal management, and comprehensive care. Study quality was assessed, data extracted, and results summarized qualitatively. Results. We identified 4,406 citations and reviewed 219 full-text articles; 19 studies were included. Two were RCTs while 17 were observational studies. The strongest evidence (moderate) was that HBPC reduces hospitalizations and hospital days. Reductions in emergency and specialty visits and in costs were supported by less strong evidence, while no or unclear effects were identified on hospital readmissions and nursing home days. Evidence about clinical outcomes was limited to studies that reported no significant differences in function or mortality. HBPC had a positive impact on patient and caregiver experience, including satisfaction, quality of life, and caregiver needs, but the strength of evidence for these outcomes was low. In studies that reported on the impact of patient characteristics, moderate evidence indicated frail or sicker patients are more likely to benefit from HBPC. No identified studies assessed the impact of organizational characteristics. No adverse events were reported. Only one study examined the potential for a negative impact; none was found. The services included in the HBPC interventions varied widely, and no identifiable combination was related to more positive outcomes. We did identify four studies that evaluated the addition of specific services. Combining palliative care and primary care home visits increased the likelihood of death at home (low strength of evidence), while studies on adding caregiver support (one study) or transitional care (one study) to HBPC were rated as insufficient evidence. Conclusions. Current research evidence is generally positive, providing moderate-strength evidence that HBPC reduces utilization of inpatient care, and providing low-strength evidence about its impact on utilization of other health services, costs, and patient and caregiver experience. Future research should focus on the content and organizational context of HBPC interventions so that experiences can be replicated or improved on by others. Additional research is also needed about which patients benefit most from HBPC and how HBPC can be best used in the continuum of care.
Authors of Report
Methodology description
We included randomized controlled trials (RCTs) and observational studies of HBPC, including home visits by a primary care provider, longitudinal management, and comprehensive care. Study quality was assessed, data extracted, and results summarized qualitatively.
Available at www.effectivehealthcare.ahrq.gov/reports/final.cfm (pending publication) Data was added retrospectively by uploading of data from Excel or Word. Relevant data in the extraction forms is located in above files.
Funding Source
This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 2902012-00014-I.).

Key Questions

1. Key Question 1. Among adults with chronic conditions that are serious or disabling, what are the effects (positive and negative) of HBPC interventions on: a. Health outcomes b. Patient and caregiver experience c. Utilization of services
2. Key Question 2. How do the effects of HBPC interventions differ across: a. Patient characteristics (including, but not limited to: reason for HBPC, type and number of diagnoses, level of physical and cognitive function, caregiver availability, and demographics) b. Organizational characteristics (including, but not limited to: ownership organizational structure, payment structure, leadership, and staffing patterns of the practice or health system providing HBPC)
3. Key Question 3. Which characteristics of home-based primary care interventions are associated with effectiveness (including, but not limited to, use of teams, composition of teams, use of technology, frequency of visits, and types of visits/services)?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

Does persistent involvement by the GP improve palliative care at home for end-stage cancer patients?2006
VNA HouseCalls of greater Cleveland, Ohio: development and pilot evaluation of a program for high-risk older adults offering primary medical care in the home.2006
Veteran's Affairs Home Based Primary Care.2009
Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge: a randomized controlled trial.2013
Impact of a home-based primary care program in an urban Veterans Affairs medical center.2009
Home-based primary care: the care of the veteran at home.2007
Geriatric care management for low-income seniors: a randomized controlled trial.2007
Is there a doctor in the house?2002
Better access, quality, and cost for clinically complex veterans with home-based primary care.2014
Effectiveness of team-managed home-based primary care: a randomized multicenter trial.2000
Home-based primary care and the risk of ambulatory care-sensitive condition hospitalization among older veterans with diabetes mellitus.
Associations between successful palliative trajectories, place of death and GP involvement.2010
Associations between home death and GP involvement in palliative cancer care.2009
Translation of a dementia caregiver support program in a health care system--REACH VA.
Can home-based primary care: cut costs?2008
To the hospital and back home again: a nurse practitioner-based transitional care program for hospitalized homebound people.
Reduction in symptoms for homebound patients receiving home-based primary and palliative care.2013
Acute hospital use, nursing home placement, and mortality in a frail community-dwelling cohort managed with Primary Integrated Interdisciplinary Elder Care at Home.2012
Hospitalizations and skilled nursing facility admissions before and after the implementation of a home-based primary care program.2010
Understanding and improving the burden and unmet needs of informal caregivers of homebound patients enrolled in a home-based primary care program.2009

Downloadable Data Content

  • XLSX Project Data