Home-based Primary Care: Impact on Cost and Patient Satisfaction

Publication Year:
2018
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Downloads 81
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Repository URL:
https://cornerstone.lib.mnsu.edu/etds/759
Author(s):
Tupper, Sarah R.
Tags:
homebound patients; nurse practitioner; physician; home visits; cost savings; patient satisfaction; office visit; primary care; chronically ill; inpatient; cost; Primary Care; Public Health and Community Nursing
artifact description
The aging American population means more people will need healthcare than ever before. Many of these people are or will be Medicare beneficiaries who are predicted to be completely or mostly homebound at some point in time. This literature review was conducted to investigate Home-based Primary Care (HBPC) and whether or not this care delivery model has impacts on cost and patient satisfaction when compared to traditional outpatient encounters. A comprehensive and robust search of the literature was conducted using four different healthcare literature databases. Relevant articles were included if the site of care was ambulatory or office-based and if the study population included hospice, palliative care, chronically ill adults, or primary care patients. Studies that examined transitional care, inpatient, or long-term care were excluded. Studies that reported on home visits by a registered nurse, physical therapist, occupational therapist, respiratory therapist, speech language pathologist, or pharmacist were also excluded, and nurse practitioner or physician home visits were included. Other exclusion parameters included pediatric patients, specialty office visits, and registered nurse only office visits. Key themes that surfaced in the literature were cost savings in addition to patient and caregiver satisfaction with HBPC. This body of evidence suggests HBPC visits by advanced practice nurses or physicians is associated with substantially improved outcomes, lower costs, and higher patient and caregiver satisfaction when compared to standard clinic visits. Given the growing number of older adults with chronic conditions who are or may become homebound, combined with the efficacy of HBPC, it seems prudent that interdisciplinary care teams innovatively deliver quality primary care in the home.