Home Healthcare Nursing Visits for Nonhomebound Patients With Heart Failure After Hospital Discharge: A Quality-Improvement Pilot Project.
Youjeong Kang, Favel L Mondesir, Dawn Young and 4 others
PMID 33417359WHAT IT FOUND
Thirty-day readmission after heart failure discharge was 15% with home healthcare nurse visits and 23% without, not proving a reduction.
The visits found gaps in weight, sodium, and self-care knowledge for ambulatory patients.
Key findings
01Thirty-day rehospitalization was 15% among patients with home healthcare nurse visits and 23% among patients without visits, with p = .12.
02Nurse home visits found frequent self-management gaps: 30% did not know their ideal baseline weight, 34% were not maintaining a vitals log, and 45% were not exercising or lacked an exercise plan.
03Assessments also found medication and social barriers: 10% had prescriptions not on insurance formulary, 3% could not fill them, 8% had medication adverse events, 12% lacked transportation, and 39% had financial barriers affecting heart failure care.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a quality-improvement pilot, not a randomised trial, and patients chose whether to take up the offered visits. The paper does not state how many patients received visits versus no visits. The 30-day rehospitalization difference was not statistically significant (p = .12). Some eligible patients declined to participate. Many patients asked for only one visit instead of the planned two, so the effect of a second visit is unknown. Different home healthcare nurses delivered visits, which may have affected consistency of education. Rehospitalizations outside the index hospital may not have been captured. The sample came from one urban hospital and city, with a large proportion of White patients, limiting generalizability.
The easy way to misread this
Do not conclude that home healthcare nurse visits reduce 30-day rehospitalization. The rates were 15% with visits and 23% without, but the difference was not statistically significant (p = .12).