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 Triﬁlio

, Donna Maloney

, Kathryn H. Bowles

2, 4

p to half of hospitalizations happen within the ﬁrst two weeks of homecare services [e.g.,

1,2

]. Early targeted

allocation of services for high risk patients has been shown to signiﬁcantly 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 ﬁrst homecare visit during homecare admission. This pilot study aimed to test the PREVENT

tool and determine its eﬀect on the timing of the ﬁrst 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 ﬁrst 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 ﬁrst 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 signiﬁcantly diﬀerent, 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, reﬂecting changes in nurses’ admission practices and almost one half a day was shaved oﬀ the wait time for

high risk patients. The study successfully tested the feasibility and workﬂow for administering and delivering the PREVENT

decision support intervention. Hospitalization outcomes all trend toward a positive eﬀect 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 ﬁrst 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

explored.

References

1. Berkowitz, SA and Anderson, GF. Medicare beneﬁciaries most likely to be readmitted. Journal of hospital medicine

2013;8:639–641.

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: Eﬀectiveness of Early and Intensive Nursing Services and Early Physician Follow-Up. Health Services Research

2016.

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