title: Hospitalizations and skilled nursing facility admissions before and after the implementation of a home-based primary care program.
abstract: OBJECTIVE
  To evaluate the effect of an urban house calls program (HCP) on healthcare utilization.
  
  
  METHODS
  Retrospective chart review with pre/post analysis.
  
  
  METHODS
  Urban home-based primary care program.
  
  
  METHODS
  All participants (N=179) in a capitated insurance program enrolled in a HCP between October 2004 and August 2006.
  
  
  METHODS
  Enrollment into HCP.
  
  
  METHODS
  Hospitalizations and skilled nursing facility (SNF) admissions before and after enrollment. Patients with at least one hospitalization or SNF admission before and after enrollment were compared using the McNemar test. Median number of hospitalizations and SNF placements before and after HCP enrollment were compared using the Wilcoxon signed-rank sum test.
  
  
  RESULTS
  Sixty-one percent of patients had one or more hospitalizations before enrollment, whereas only 38% had one or more hospitalizations after enrollment (P<.001). Thirty-eight percent of patients had at least one SNF placement before enrollment, compared with 18% after enrollment (P=.001). The median hospitalization rate decreased from 1 to 0; the median SNF placement rate was 0 (interquartile range 0-1) before enrollment and 0 (interquartile range 0-0) after enrollment (P<.001).
  
  
  CONCLUSIONS
  A HCP may be associated with fewer hospitalizations and SNF placements. Models of care that reduce morbidity and preserve quality of life are critical to help homebound older adults remain in their communities.
authors.affiliation: Mount Sinai Visiting Doctors Program, Department of General Internal Medicine, Mount Sinai School of Medicine, New York, New York, USA. ania.wajnberg@mountsinai.org
authors.forename: Ania
authors.initials: A
authors.lastname: Wajnberg
authors.forename: Karen H
authors.initials: KH
authors.lastname: Wang
authors.forename: Mohamed
authors.initials: M
authors.lastname: Aniff
authors.forename: Hillary V
authors.initials: HV
authors.lastname: Kunins
mesh_terms: D000368:Aged; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011320:Primary Health Care; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric