title: Integrating Physician Services in the Home: evaluation of an innovative program.
abstract: OBJECTIVE
  To evaluate a new program, Integrating Physician Services in the Home (IPSITH), to integrate family practice and home care for acutely ill patients.
  
  
  METHODS
  Causal model, mixed-method, multi-measures design including comparison of IPSITH and non-IPSITH patients. Data were collected through chart reviews and through surveys of IPSITH and non-IPSITH patients, caregivers, family physicians, and community nurses.
  
  
  METHODS
  London, Ont, and surrounding communities, where home care is coordinated through the Community Care Access Centre.
  
  
  METHODS
  A total of 82 patients receiving the new IPSITH program of care (including 29 family physicians and 1 nurse practitioner), 82 non-randomized matched patients receiving usual care (and their physicians), community nurses, and caregivers.
  
  
  METHODS
  Emergency department (ED) visits and satisfaction with care. Analysis included a process evaluation of the IPSITH program and an outcomes evaluation comparing IPSITH and non-IPSITH patients.
  
  
  RESULTS
  Patients and family physicians were very satisfied with the addition of a nurse practitioner to the IPSITH team. Controlling for symptom severity, a significantly smaller proportion of IPSITH patients had ED visits (3.7% versus 20.7%; P = .002), and IPSITH patients and their caregivers, family physicians, and community nurses had significantly higher levels of satisfaction (P < .05). There was no difference in caregiver burden between groups.
  
  
  CONCLUSIONS
  Family physicians can be integrated into acute home care when appropriately supported by a team including a nurse practitioner. This integrated team was associated with better patient and system outcomes. The gains for the health system are reduced strain on hospital EDs and more satisfied patients.
authors.affiliation: University of Western Ontario, Family Medicine, Suite 245, 100 Collip Circle, London, ON N6G 4X8. moira@uwo.ca
authors.forename: Moira
authors.initials: M
authors.lastname: Stewart
authors.forename: John F
authors.initials: JF
authors.lastname: Sangster
authors.forename: Bridget L
authors.initials: BL
authors.lastname: Ryan
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
authors.forename: Irene
authors.initials: I
authors.lastname: Cohen
authors.forename: Carol L
authors.initials: CL
authors.lastname: McWilliam
authors.forename: Joan
authors.initials: J
authors.lastname: Mitchell
authors.forename: Evelyn
authors.initials: E
authors.lastname: Vingilis
authors.forename: Christine
authors.initials: C
authors.lastname: Tyrrell
authors.forename: Ian R
authors.initials: IR
authors.lastname: McWhinney
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D017060:Patient Satisfaction; D010821:Physicians, Family / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012923:Social Class