Purpose and Goals: The purpose of this project was to describe and evaluate this innovative NP home visit intervention in the context of a multi-intervention readmission reduction program for high risk for readmission medicine patients by completing a retrospective chart review of a subset of the patients seen by the NP in the 30 days post hospital discharge. The goal was to determine the key interventions the NP performs as this innovative role is included in an effective hospital readmission reduction program.
Methodology: A descriptive study design using a retrospective chart review with chart extraction form was utilized. The extraction form included, but was not limited to: patient demographics, diagnosis, NP interventions, adverse events and readmissions to the discharging institution. The selected charts were a subset of patients who received the NP home visits as a part of the Stay Connected Program. The patient sample was selected from an enrollment excel spreadsheet. All patients admitted to the NP home visit intervention in the time period of July 1, 2017 – September 30, 2017 were selected for the chart review without any exclusions. A sample size of 100 charts was targeted and/or sample size will be concluded sooner if theme saturation is reached.
Results: This study is in progress. Descriptive and comparative statistics will be utilized to analyze data.
Implications for Future: This study will add to the body of evidence to support a strategic approach to reduce hospital readmissions and could potentially be a great value to institutions trying to reduce HRR program financial penalties and inpatient capacity. This study will also support the diverse contributions of the advanced practice nurse to high quality patient care and inclusion of an NP role in the home care setting. Next steps would be to examine this NP role individually to directly link this intervention to readmission reduction.