Contact email

dmlevine@bwh.harvard.edu

Overview

This pilot randomized control trial compared a single physician home visit with 4 days of discharge from the hospital to usual care and demonstrated trends toward reduced readmissions and ED presentation and better follow up, though results were not statistically significant at the size of the pilot. This study is the first study of a physician home visit following discharge known to the researchers.

Department

Medicine

Division

General Internal Medicine

Collaborators

David M. Levine
Kei Ouchi
Mary R. Paz
Kimberly P. Burke
Jeffrey L. Schnipper

Status/Stage of Development

Pilot

Measurement

The primary endpoint was having at least one new or worsening symptom at 30-days post-discharge, captured by a structured phone interview used in prior research. Our secondary endpoints included 30- day readmission, 30-day emergency department (ED) utilization, 14-day PCP utilization, and readiness to transition via the Care Transition Mea- sure (CTM)-3.

Results

-The pilot included 51 patients, 26 home visits and 25 controls.
-There was no difference in new or worsening symptoms between the 2 groups at 30 days.
-The home visit group had nonsignificant trends toward fewer 30 day readmissions, fewer 30 day ED presentations, and improved PCP follow up rate at 14 days
-There was no difference in the Care Transition Measure between groups
-9 intervention patients had medication changes as a result of their home physician visits.

Patient Population Served and Payor Information

-Patients lived within 5 miles of Brigham and Women’s Hospital

-The study enrolled patients whose inpatient care teams felt they would benefit from a physician home visit for any reason.

-Patients were randomized after enrollment.

-Patients who received home visits had a median age of 65, 65% were female, 81% underrepresented minorities, and 35% had less than a high school education. The control group was similar, except it had fewer underrepresented minorities (68%).

Sources

David M. Levine, Kei Ouchi, Mary R. Paz, Kimberly P. Burke, Jeffrey L. Schnipper. Physician Home Visits After Hospital Discharge: A Pilot Randomized Controlled Trial [abstract]. In: SGIM Annual Meeting 2019.;May 8-May 11; Washington D.C.