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Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

Fri, Nov 3, 2017
Friday, Nov 3, 2017, Washington - D.C.
H3IT: Home Healthcare, Hospice, and Information Technology Conference Chicago, IL, 2016
Improving Patient Prioritization during Homecare
Admission: A Pilot Study
Maxim Topaz
1, 2
, Marygrace Trilio
, Donna Maloney
, Kathryn H. Bowles
2, 4
p to half of hospitalizations happen within the rst two weeks of homecare services [e.g.,
]. Early targeted
allocation of services for high risk patients has been shown to signicantly reduce 30-day readmissions for heart
failure patients.
Recently, we developed a tool called PREVENT to facilitate decision making on patient prior-
itization for the rst homecare visit during homecare admission. This pilot study aimed to test the PREVENT
tool and determine its eect on the timing of the rst nursing visit from hospital discharge (i.e. whether high risk patients
were prioritized for care) and on average readmissions rates and time to readmission.
Methods: This pre-post, quasi-experimental, pilot study was conducted at a large, homecare agency in NewYork (NY, USA)
with 176 patients admitted to homecare after a hospital stay. In the pre-experimental phase, we calculated the PREVENT
priority score on 90 randomly selected patients but did not share the scores with the intake nurses. Prior to the post phase,
we educated the intake nurses and regional teams about the PREVENT tool and asked them to prioritize the rst visit for
patients who scored high risk on the PREVENT tool. The PREVENT score was then computed by intake nurses for 86
randomly selected patients and visit priority (high or medium/low) was communicated to the regional teams responsible for
patient admission. Timing of the rst homecare visit and hospital admission information were extracted from the homecare
administrative records. This study received IRB approval from the homecare organization.
Results: On average, patients in both phases were seen within two days of hospital discharge. In the pre-experimental phase,
72% of patients were high priority compared to 78% patients in the experimental phase (p =.35). During the pre-experimental
phase, both high and medium/low priority patients were admitted to homecare on average 2.2 days after hospital discharge
whereas in the experimental phase, high risk patients were admitted one-half day sooner (1.8 days) and medium/low priority
patients within 2.6 days. Thirty-four percent of patients were readmitted within an average of 21.9 days (SD = 15) in the
pre-experimental phase versus 30% of patients in the experimental phase within an average of 26.5 days (SD =18.8). Further,
hospital admission rates decreased in both high risk (32.8% vs. 36.9%) and medium/low risk patients (21% versus 28%)
between the pre and post experimental phases. Although none of the outcomes were statistically signicantly dierent, all
outcomes trended in the expected direction.
Discussion: In the experimental phase, high risk patients were admitted to homecare almost one day sooner than medium/low
risk patients, reecting changes in nurses’ admission practices and almost one half a day was shaved o the wait time for
high risk patients. The study successfully tested the feasibility and workow for administering and delivering the PREVENT
decision support intervention. Hospitalization outcomes all trend toward a positive eect of the PREVENT tool, however
further study is needed with a larger sample under randomized conditions to eliminate confounders.
Conclusion: This pilot study of patient prioritization for the rst homecare nursing visit showed promising results. After
applying and sharing the PREVENT tool with the nurses, high priory patients were seen sooner and overall hospital ad-
mission rates decreased. Future work is necessary to validate these results using a larger sample in a randomized controlled
trial. Combining home visit prioritization with other early interventions such as early followup doctor visits should be further
1. Berkowitz, SA and Anderson, GF. Medicare beneciaries most likely to be readmitted. Journal of hospital medicine
2. O’connor, M, Hanlon, A, and Bowles, KH. Impact of frontloading of skilled nursing visits on the incidence of 30-day
hospital readmission. Geriatric Nursing 2014;35:S37–S44.
3. Murtaugh, CM, Deb, P, Zhu, C, et al. Reducing Readmissions among Heart Failure Patients Discharged to Home Health
Care: Eectiveness of Early and Intensive Nursing Services and Early Physician Follow-Up. Health Services Research
Brigham and Women’s Hospital, Boston, MA, USA
Harvard Medical School, Boston, MA, USA
Visiting Nurse Service of New York, NY, USA
School of Nursing, University of Pennsylvania , PA, USA
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