Hospitalizations and skilled nursing facility admissions before and after the implementation of a home-based primary care program

Objectives: To evaluate the effect of an urban house calls program (HCP) on healthcare utilization. Design: Retrospective chart review with pre/post analysis. Setting: Urban home-based primary care program. Participants: All participants (N=179) in a capitated insurance program enrolled in a HCP between October 2004 and August 2006. INTERVENTION: Enrollment into HCP. Measurements: 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). Conclusion: 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.