Evaluating the Efficacy of a House Call Program in Primary Care

Background: Providing care in the home allows homebound patients to spend more time with their primary care provider in the comfort of their surroundings. It is often hard for these patients to see their primary care provider in the office because of debility or lack of resources. As a result, this population has been shown to have poorer health outcomes and a higher likelihood of using high cost health services (CMS, 2015).

Purpose: Evaluate the efficacy of a house call program in primary care, to improve the quality of care of older adults who are homebound by encouraging healthcare delivery change.

Method: Using the Stetler (2001) model of research utilization, the efficacy of house call visits was evaluated by comparing the relative risk of hospital use of patients receiving care through a house call, and those who received care in the clinic. The data collected was extracted from a retrospective cohort chart review using the electronic medical record. Two groups were compared, hospice patients who were receiving house calls and patients receiving care in the clinic. Eligibility included 65 years of age and older with 2 or more of the following chronic conditions: cardiovascular disease, osteoarthritis, cancer, diabetes and obesity. The Charlson (1987) co-morbidity index was used to ensure a homogenous sample. The relative risk of hospitalization was calculated by comparing the proportion of the two groups. the relative risk was defined as the ratio of the risk of going to the hospital among those receiving house calls and those who do not receive house calls. The chi square test was used to determine the statistical significance of the results.

Result: The relative risk of using the hospital was half the risk (0.54) of those receiving house calls compared to the non-house call group. These findings are congruent with the literature reviewed in terms of reduction in hospital admission.

Practice Implications: Older adults who have chronic conditions might benefit from a house call program by reducing the risk of hospitalization, and would be beneficial to all stakeholders in terms of better health outcomes, possible cost reduction, patient satisfaction and provider job satisfaction.