NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Structured Abstract
Objective:
To assess the available evidence about home-based primary care (HBPC) interventions for adults with serious or disabling chronic conditions.
Data sources:
Articles from January 1998 through May 2015 were identified using Ovid MEDLINE®, CINAHL®, ClinicalTrials.gov, Cochrane Database of Systematic Reviews, reference lists, and gray literature databases.
Review methods:
We included randomized controlled trials (RCTs) and observational studies of HBPC, including home visits by a primary care provider, longitudinal management, and comprehensive care. Study quality was assessed, data extracted, and results summarized qualitatively.
Results:
We identified 4,406 citations and reviewed 221 full-text articles; 19 studies were included. Two were RCTs, while 17 were observational studies.
The strongest evidence (moderate) was that HBPC reduces hospitalizations and hospital days. Reductions in emergency and specialty visits and in costs were supported by less strong evidence, while no or unclear effects were identified on hospital readmissions and nursing home days. Evidence about clinical outcomes was limited to studies that reported no significant differences in function or mortality. HBPC had a positive impact on patient and caregiver experience, including satisfaction, quality of life, and caregiver needs, but the strength of evidence for these outcomes was low.
In studies that reported on the impact of patient characteristics, moderate evidence indicated that frail or sicker patients are more likely than others to benefit from HBPC. No identified studies assessed the impact of organizational characteristics. No adverse events were reported. Only one study examined the potential for a negative impact; none was found.
The services included in the HBPC interventions varied widely, and no identifiable combination was related to more positive outcomes. We identified four studies that evaluated the addition of specific services. Combining palliative care and primary care home visits increased the likelihood of death at home (2 studies; low strength of evidence), while studies on adding caregiver support (1 study) or transitional care (1 study) to HBPC were rated as having insufficient evidence.
Conclusions:
Current research evidence is generally positive, providing moderate-strength evidence that HBPC reduces use of inpatient care and providing low-strength evidence about its impact on use of other health services, costs, and patient and caregiver experience. Future research should focus on the content and organizational context of HBPC interventions so that experiences can be replicated or improved on by others. Additional research is also needed about which patients benefit most from HBPC and how HBPC can best be used in the continuum of care.
Contents
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Introduction
- Methods
- Results
- Discussion
- Conclusions
- References
- Abbreviations and Acronyms
- Appendix A Methods
- Appendix B Included Studies
- Appendix C Excluded Studies
- Appendix D Included and Excluded Studies Criteria
- Appendix E Evidence Table
- Appendix F Quality Rating
- Appendix G Strength of Evidence
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2012-00014-I. Prepared by: Pacific Northwest Evidence-based Practice Center, Portland, OR
Suggested citation:
Totten AM, White-Chu EF, Wasson N, Morgan E, Kansagara D, Davis-O'Reilly C, Goodlin S. Home-Based Primary Care Interventions. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2012-00014-I.) AHRQ Publication No. 15(16)-EHC036-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2016. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00014-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.
This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report.
- 1
5600 Fishers Lane, Rockville, MD 20857; www
.ahrq.gov
- NLM CatalogRelated NLM Catalog Entries
- Review Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force[ 2013]Review Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task ForceLin JS, O'Connor E, Rossom RC, Perdue LA, Burda BU, Thompson M, Eckstrom E. 2013 Nov
- Review Telehealth for Acute and Chronic Care Consultations[ 2019]Review Telehealth for Acute and Chronic Care ConsultationsTotten AM, Hansen RN, Wagner J, Stillman L, Ivlev I, Davis-O’Reilly C, Towle C, Erickson JM, Erten-Lyons D, Fu R, et al. 2019 Apr
- Review Screening for Chronic Obstructive Pulmonary Disease: A Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2016]Review Screening for Chronic Obstructive Pulmonary Disease: A Systematic Evidence Review for the U.S. Preventive Services Task ForceGuirguis-Blake JM, Senger CA, Webber EM, Mularski R, Whitlock EP. 2016 Apr
- Review Team-Based Models for End-of-Life Care: An Evidence-Based Analysis.[Ont Health Technol Assess Ser....]Review Team-Based Models for End-of-Life Care: An Evidence-Based Analysis.Health Quality Ontario. Ont Health Technol Assess Ser. 2014; 14(20):1-49. Epub 2014 Dec 1.
- Review Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2014]Review Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task ForcePiper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP. 2014 Dec
- Home-Based Primary Care InterventionsHome-Based Primary Care Interventions
- Yttrium-90 Microspheres for Intermediate- or Advanced-Stage Hepatocellular Carci...Yttrium-90 Microspheres for Intermediate- or Advanced-Stage Hepatocellular Carcinoma
- Peroxisome biogenesis disorder 14BPeroxisome biogenesis disorder 14BMedGen
- C3554055[conceptid] (1)MedGen
Your browsing activity is empty.
Activity recording is turned off.
See more...