Characterizing the high-risk homebound patients in need of nurse practitioner co-management.
Masha G Jones, Katherine A Ornstein, David M Skovran and 2 others
PMID 27876403WHAT IT FOUND
Homebound patients referred to nurse practitioner and physician co-management were younger but had more medical conditions, more hospitalizations and more home visits before enrollment than others.
Recurrent admissions, wound care, symptom burden and frequent visit needs can flag patients needing closer follow-up.
Key findings
01Patients referred to co-management were younger than other homebound patients but had higher comorbidity scores, more hospitalizations and more home visits before enrollment.
02Physicians most often referred homebound patients because of recurrent hospitalization, need for more frequent home visits, complex wound care and high symptom burden.
03Providers said co-management was more indicated for acute medical issues than end-of-life care, and reported faster telephone response, more urgent visit availability and earlier post-discharge visits.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only one nurse practitioner delivered the intervention, so the results may reflect that provider's background and style rather than the co-management model itself. Referral was not mandatory and physicians may not have used uniform criteria, so referred and non-referred patients may differ in ways the study did not measure. The physician survey was created for this study and not formally validated, and only 13 physicians were surveyed. The focus group included only 5 social workers and 2 registered nurses, so their views may not represent all staff. The study did not assign patients at random, so it cannot show that co-management caused the observed differences in visits or hospitalizations. The increase in total home visits after enrollment was reported with P = 0.067, so it was not a clear change.
Declared interests
The supplied text does not include a conflicts-of-interest declaration; the publication metadata lists non-U.S. government and NIH extramural research support.
The easy way to misread this
Do not conclude that nurse practitioner and physician co-management caused fewer hospitalizations or better outcomes. The study did not randomise patients, referral criteria were not uniform, and the reported increase in total home visits after enrollment had P = 0.067.