Home-based primary care for the aging: The role of the nurse practitioner

Objective: Home-based primary care (HBPC) programs consistently demonstrated cost-savings, reduction in admission to skilled nursing facilities, reduction in hospital (re)admissions, and improved disease management. The value of the Nurse Practitioner (NP) in these programs has not been well documented. This case study profiles the MedStar Washington Hospital Center’s (MWHC) Medical House Calls (MHC) Program with the intent to take a closer look at the role of the NPs, and the successes and challenges of implementing this model. Methodology: A systematic review of literature was conducted and program outcome data was analyzed, complemented by observation of a MHC staff meeting and home visit, in addition to interviews with the MHC program administrator and a NP. Results: HBPC gives providers the time and resources to address social determinants of their patients’ health through close collaborative work. The mix between autonomy and a nursing foundation make the NP an ideal fit as a main primary care provider in the MHC Program. The MHC Program demonstrated lower emergency room visits and hospitalizations during Fiscal Year 2013 (FY13) compared to nationwide statistics which is consistent with existing literature on HBPC. This success is credited to MHC Program interventions which includes high levels of education provided to patients about hospitalizations and early follow up after discharge. Recommendations: The authors recommend further research into the financial sustainability and long-term cost savings of HBPC; more research into the value of multidisciplinary care and NP-led teams; and the establishment of benchmark indicators to measure and compare outcomes.