Impact of home-based primary care on healthcare utilization: A prospective study of the homebound elderly

The aging population in the U.S. calls for increased attention to the healthcare needs of seniors. Many medically complex community-dwelling seniors are homebound due to functional impairment,which limits their access to regular primary care. We conducted a prospective observational cohort study to examine the impact of home-based primary care on hospitalization rates for seniors who were newly enrolled in the Mount Sinai Visiting Doctors (MSVD) program in comparison to adults receiving long-term care through the Visiting Nurse Services of New York (VNS), recruiting 180 patients. Our main outcome measure was use of inpatient services during the one year period after service enrollment. Data on hospital admissions, deaths, and program discharges were recorded using Medicare surveys and chart reviews. The incidence of hospital admissions for MSVD patients was compared with VNS using negative binomial regression and propensity score analysis to adjust for differences between groups. Forty-two percent of participants were ≥85 years of age, 81% were female, 29% Black, 39% Hispanic, 71% earned ≤$1350 a month, and 71% had ≥3 functional limitations. MSVD patients were older (p<0.0001), more disabled (p<0.0001), and had higher incomes (p=0.03) than VNS patients. Propensity scores successfully balanced groups. Propensity score adjusted results showed a 26% decrease in hospital admissions per day observed for patients in the MSVD as compared with the VNS group, however this difference was not statistically significant (IRR 0.74 (0.38-1.41), p=0.36). Further research with larger cohorts is needed to better understand the impact of home-based care on hospitalizations for this population.