The cost of health care in the United States continues to increase. Implementing innovative approaches to health professions education is one strategy aimed at reducing costs and improving patient outcomes. Interprofessional education (IPE) occurs when two or more health professions learn from, with, and about each other (World Health Organization, 2010).
An assumption exists that when health care professionals learn together, whether as students, or when they are licensed practitioners, their communication with each other will be better-quality, thus leading to improved patient outcomes (Reeves et al., 2016). Currently, the goal in IPE research is show more linkages between IPE and patient outcomes.
Super-utilizers are the costliest group to the health care system. They have complex medical histories, are psychologically fragile, and are at elevated risk for negative health outcomes (Mercer et al., 2015). This group of patients has numerous hospital admissions and readmissions (Dattalo, Nothelle, & Chapman, 2016). Hospital readmissions account for over $17 million in annual Medicare spending (Kripalani, Theobald, Anctil, & Vasilevskis, 2014). Further focusing on the outcomes of older adults in home and community settings is also an area in IPE that needs more research focus (Ploeg et al., 2017). The purpose of this quasi-experimental study was to determine the impact of IPE student-team home health visits on the health outcome of hospital readmissions for super-utilizers of the health care system.
Methods:
Through a partnership with a statewide home health agency, our students were connected to patients who were classified as super-utilizers through a readmission-risk scoring tool. Personnel from this agency provided patient contact information. Patients were contacted by a graduate nurse research assistant to obtain consent for the home visits. During the home visits, students used a structured interview guide to establish rapport and engage patients in a dialogue. The students inquired about patients’ health care goals and identified any barriers to achieving these goals. A firm plan was in place for the students to communicate immediate concerns to the home health agency. Students participated in debriefing sessions about the visits and welcomed peer feedback about any additional recommendations for patient education that that students could take back to subsequent visits.
Results:
Twelve health professions students performed 32 home visits over a 7-month period Most visits were performed by nursing and public health students. Both the intervention and control group contained 20 patients. Thirty-day readmissions for the two groups were compared using the Chi-square test of association. There was a statistically significant difference between the groups (c2=4.286, df=1, p=0.038). The intervention group had three readmissions and the control group had nine readmissions. This equated to a potential cost savings of $82,800-$95,544.
Conclusion:
Hotspotting in home health as an interprofessional educational endeavor aimed at improving patient outcomes showed favorable results. This type of intervention has the potential to be scaled up and sustainable with the appropriate infrastructure in place. The findings support expanding IPE initiatives, as well as hotspotting initiatives in particular, to further determine the impact of IPE on patient outcomes.