title: Reduced emergency room and hospital utilization in persons with multiple chronic conditions and disability receiving home-based primary care.
abstract: Persons with multiple chronic conditions and disability face access barriers to office-based primary care and have very high rates of emergency department (ED) use and hospital admissions. Home-based primary care (HBPC) has been proposed as a way to improve disease management and prevent health crises.
  
  
  
  Enrollment of patients with disability and multiple chronic conditions in a HBPC program is associated with a subsequent decrease in ED visits and hospital admissions.
  
  
  
  We abstracted electronic medical record (EMR) data among patients receiving HBPC and compared rates per 1000 patient days for ED visits, admissions, 30-day readmissions, and inpatient days for up to three years before and after enrollment.
  
  
  
  Of 250 patients receiving HBPC, 153 had admission data recorded in our EMR prior to enrollment. One year after HBPC enrollment, the rate of admissions dropped by 5.2 (95% confidence interval 4.3, 6.0), 30-day readmissions by 1.8 (1.3, 2.2) and inpatient days by 54.6 (52.3, 56.9) per 1000 patient-days. Three years post-enrollment, rates remained below baseline by 2.2 (1.3, 3.1) for admissions, 0.5 (0.04, 1.0) for 30-day readmissions and 32.2 (29.8, 34.7) for inpatient days. Among 91 patients with pre-enrollment ED data, the rate of ED visits also dropped at one and three years by 5.5 (4.6, 6.4) and 2.7 (1.7, 3.7), respectively.
  
  
  
  Provision of HBPC for persons with multiple chronic conditions and disability is associated with a persistent reduction in ED and hospital use.
authors: Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. Electronic address: andrew.schamess@osumc.edu.
authors: Andrew
authors: A
authors: Schamess
authors: Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
authors: Randi
authors: R
authors: Foraker
authors: Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
authors: Matthew
authors: M
authors: Kretovics
authors: Division of Pharmacy Practice and Administration, The Ohio State University College of Pharmacy, Columbus, OH, USA.
authors: Kelli
authors: K
authors: Barnes
authors: Division of Pharmacy Practice and Administration, The Ohio State University College of Pharmacy, Columbus, OH, USA.
authors: Stuart
authors: S
authors: Beatty
authors: Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
authors: Seuli
authors: S
authors: Bose-Brill
authors: Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
authors: Neeraj
authors: N
authors: Tayal
mesh_terms: D000328:Adult; D000368:Aged; D006233:Persons with Disabilities; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006699:Home Care Services; D006760:Hospitalization; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071069:Multiple Chronic Conditions / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care
keywords: Disability; Health service utilization; Home-based primary care; Hospital readmission; Multiple chronic conditions