Evidence map›Paper›PMID 33412440›Full record

ArticleHealthcare (Amsterdam, Netherlands)2021

Healthcare utilization and patient and provider experience with a home visit program for patients discharged from the hospital at high risk for readmission.

Anita D Misra-Hebert, Michael B Rothberg, Jaqueline Fox, Xinge Ji, Bo Hu, Alex Milinovich, William Zafirau, Anthony Onuzuruike, Kurt C Stange

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Healthcare (Amsterdam, Netherlands), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Article
  5. Article
  6. The development of community paramedicine; a restricted review.Health & social care in the community · 2022
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Anita D Misra-HebertDepartment of Internal Medicine, Cleveland Clinic Community Care, USA; Healthcare Delivery and Implementation Science Center, Cleveland Clinic, USA; Center for Value-Based Care Research, Cleveland Clinic Community Care, USA; Department of Quantitative Health Sciences, Cleveland Clinic, USA. Electronic address: misraa@ccf.org.
Michael B RothbergDepartment of Internal Medicine, Cleveland Clinic Community Care, USA; Center for Value-Based Care Research, Cleveland Clinic Community Care, USA.
Jaqueline FoxCenter for Value-Based Care Research, Cleveland Clinic Community Care, USA.
Xinge JiDepartment of Quantitative Health Sciences, Cleveland Clinic, USA.
Bo HuDepartment of Quantitative Health Sciences, Cleveland Clinic, USA.
Alex MilinovichDepartment of Quantitative Health Sciences, Cleveland Clinic, USA.
William ZafirauDepartment of Connected Care, Cleveland Clinic Community Care, USA.
Anthony OnuzuruikeCleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Kurt C StangeCenter for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA.

Funding

Impact of a Team-based Approach to Primary Care: A Natural Experiment in Primary Care RedesignK08HS024128 · AHRQ · CLEVELAND CLINIC FOUNDATION · PI MISRA-HEBERT, ANITA DIANA · 2016 to 2020
$738k
AHRQ HHS K08 HS024128
6 · The paper itself

Abstract

backgroundHome visits after hospital discharge may reduce future healthcare utilization. We assessed the association of home visits by advanced practice registered nurses (APRN) and paramedics with healthcare utilization and mortality, and provider and patient experience.

methodsWe conducted a retrospective cohort study using convergent mixed methods in one health system including adult medical patients discharged to home from November 2017-September 2019. We assessed outcomes for home visit vs. matched comparison patients at 30, 90, and 180 days, including hospital admission, emergency department (ED) use, and death: Phase 1 (APRN or paramedic visits assigned by geographic location) and Phase 2 (APRN and paramedic visit teams assigned to patients). Patients declining home visits and those accepting were also compared. Semi-structured interviews were conducted with home visit patients and providers, primary care providers, and nurse care coordinators.

resultsIn Phase 1, the 101 home visit matched to 303 comparison patients showed no differences in readmissions, ED visits, or death at 30, 90, and 180 days. In Phase 2, 157 home visit matched to 471 comparison patients had fewer 30-day readmissions (19.1% vs. 28.7%, p 0.024) and no differences in other outcomes. Compared with patients declining home visits, patients accepting had lower odds of 30-day readmission. In 44 interviews, themes of Medication Understanding, Knowledge Gap after Discharge, Patient Medical Complexity, Social Context, and Patient Engagement/Need for Reassurance emerged.

conclusionPost-discharge home visits by APRNs and paramedics working together were associated with reduced 30-day readmissions. Identified themes could inform strategies to improve patient support.

Indexed as

Patient DischargePatient ReadmissionAdultAftercareEmergency Service, HospitalHospitalsHouse CallsHumansPatient Acceptance of Health CareRetrospective StudiesHome care servicesHospital readmissionPrimary health care

Identifiers

PMID33412440
PMCPMC9092948

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.