Home-based primary care visits by nurse practitioners.
Chun-An Sun, Chad Parslow, Ja'Lynn Gray and 3 others
PMID 35439205WHAT IT FOUND
Nurse practitioner home-based primary care visits, sometimes with physicians or social workers, were associated with fewer hospitalizations and nursing home admissions, but health status and cost results were mixed.
Key findings
01Ten of twelve studies found fewer hospitalizations with home-based primary care led by nurse practitioners, sometimes with physicians or social workers.
02Functional status improved in two of three studies, while subjective health outcomes were inconsistent.
03One study found lower mean post-intervention year costs for high hospitalization-risk patients, but two-year total costs were not different.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 14 unique studies were included, and most were quasi-experimental; only two of eight quasi-experimental studies had a control group, which weakens causal inference. In the randomized trials, participants and interventionists were not blinded, and allocation was not concealed in some studies. One randomized trial stratified the sample before randomization but did not report stratum-specific estimates. Interventions varied, and in some studies nurse practitioners worked with physicians or social workers, so the effect of any single component cannot be separated. The search included only English-language studies conducted in the United States and did not include gray literature, so publication bias may exist. Included studies ranged from 1985 to 2019, and older studies may reflect narrower NP practice authority than current practice. Samples were predominantly female and self-identified as White, which may limit generalizability.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not read the reduced hospitalizations as proof that NP visits alone work for every home-based primary care patient. In some studies NPs worked with physicians or social workers, and the contribution of any single component cannot be separated. Most included studies were quasi-experimental, many lacked control groups, and health status and cost results were mixed.