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Care transition option involves house calls
Full services offered at home
Hospital readmission data often show that people who fail to see their primary care physician in a timely manner are more likely than other patients to return to the hospital within 30 days, a hospital performance improvement expert says.
Hospitals have addressed this problem through a variety of strategies, including nursing follow-up and phone calls, referring patients to transitional primary care clinics, and having a hospitalist or nurse call community providers to make appointments for patients. But there is one more new strategy that some hospitals are trying: referring patients to a physician house call service.
"The physician who goes to the house will see the patient within 30 days, serving as a bridge to the primary care physician," says Beverly Cunningham, MS, RN, vice president of clinical performance improvement at Medical City Dallas Hospital.
This is a physician-to-physician consult. A hospitalist will refer patients to the house call service based on the patient's case complexity, readmission risk, and the patient's preference.
The physicians making house calls can see the more complex patients who could stay at home with some extra medical support, Cunningham notes.
Physician house calls today are more technology-driven than 40 years ago. Physicians may visit the home with an assortment of clinic equipment, including lab and imaging machinery.
One company called American Physician Housecalls in Dallas can do in a patient's home most of the same diagnostic work a primary care clinic can do. This includes ultrasounds, echocardiogram studies, pulmonary function test, blood draws, and X-rays, says Donald Graneto, MD, director of transitional care for American Physician Housecalls.
There is a growing number of physician house call services marketed nationwide to older patients and others, but the latest trend is for these to have a hospital transitional care component.
"We started this model with different hospitals in our community," Graneto says. "What our transitional care service does is talk with hospital case managers to set up things for patients before they're discharged home."
Typically, hospitals will refer patients who might be unreliable in self-management of their chronic illness. An example is a diabetes patient who sometimes forgets to take his insulin. This patient has an episode, is hospitalized, and then returns home with hospital discharge instructions. But then he continues to have difficulty remembering his medications and is re-hospitalized, Graneto explains.
A physician house call service can visit this patient soon after discharge to check his blood glucose levels and to reinforce the hospital's discharge and medication instructions. It might mean the physician refers the patient to a home care nurse for follow-up care and assistance.
Often the patients who do well with the house call service are people who may lack adequate family support due to the complexity of their cases or other reasons.
"These are complex patients going home, and they have the potential to bounce back," Cunningham says. "Their families could take care of them if they had a service available with physician house calls."
Medical City Dallas Hospital has been using American Physician Housecalls' hospital transitional care service for a few months. Now the hospital's emergency department (ED) physicians also are evaluating the program to see if it might help them with patients who make frequent ED visits, she adds.
It might also help with patients who go through the ED and then are admitted to the hospital because there are no suitable community options for their care.
An important part of hospital transitional care services and physician house calls is care coordination, Graneto says.
Physicians making house calls can evaluate the patient's caregiver support and review home health care services for the patient, he says.
Also, the house call physician provides a plan of care based on the hospital's discharge information. The goal is to prevent hospitalization and implement a plan that might include home health services, office visits to specialists, therapy, wound care, end-of-life discussions, and even community services like Meals on Wheels.
After the 30 days, the patient either will be transitioned back to his or her usual primary care provider or stay with the house call service, depending on his or her preference.
Medical City Dallas Hospital has no outcomes data yet on its use of the physician house call service, but anecdotal evidence suggests it's accomplishing the goal of reducing readmissions, Cunningham says.
"We haven't seen the patients come back, so it's like no news is good news," she says.
Beverly Cunningham, MS, RN, Vice President of Clinical Performance Improvement, Medical City Dallas Hospital, 7777 Forest Lane, Dallas, TX 75230. Telephone: (972) 566-6824. Email: email@example.com.
Donald Graneto, MD, Director of Transitional Care, American Physician Housecalls, 3100 McKinnon St., Suite 400, Dallas, TX 75201. Telephone: (214) 754-8700 or (866) 377-7595. Email: firstname.lastname@example.org.