title: Characterizing the high-risk homebound patients in need of nurse practitioner co-management.
abstract: By providing more frequent provider visits, prompt responses to acute issues, and care coordination, nurse practitioner (NP) co-management has been beneficial for the care of chronically ill older adults. This paper describes the homebound patients with high symptom burden and healthcare utilization who were referred to an NP co-management intervention and outlines key features of the intervention. We compared demographic, clinical, and healthcare utilization data of patients referred for NP co-management within a large home-based primary care (HBPC) program (n = 87) to patients in the HBPC program not referred for co-management (n = 1027). A physician survey found recurrent hospitalizations to be the top reason for co-management referral and a focus group with nurses and social workers noted that co-management patients are typically those with active medical issues more so than psychosocial needs. Co-management patients are younger than non-co-management patients (72.31 vs. 80.30 years old, P < 0.001), with a higher mean Charlson comorbidity score (3.53 vs. 2.47, P = 0.0001). They have higher baseline annual hospitalization rates (2.27 vs. 0.61, P = 0.0005) and total annual home visit rates (13.1 vs. 6.60, P = 0.0001). NP co-management can be utilized in HBPC to provide intensive medical management to high-risk homebound patients.
authors.affiliation: Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA. Electronic address: mgj9001@nyp.org.
authors.forename: Masha G
authors.initials: MG
authors.lastname: Jones
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Ornstein
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Skovran
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Soriano
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
authors.forename: Linda V
authors.initials: LV
authors.lastname: DeCherrie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D017144:Focus Groups; D006699:Home Care Services; D018577:Homebound Persons / Q000523:psychology*; D006792:House Calls; D006801:Humans; D008297:Male; D009722:Nurse Practitioners; D010348:Patient Care Team; D010359:Patient Readmission; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D011795:Surveys and Questionnaires
keywords: Advanced practice nursing; Elderly; Home health; Homebound; Primary care delivery