The number of avoidable hospitalizations is reduced when nursing and primary care are delivered in shared private homes.
Collaborative care and effective management of medical conditions that can be treated in ambulatory settings can lower rates of avoidable hospitalizations. Avoidable hospitalizations, a measure of quality of care, occur when a condition that can be treated in an outpatient setting causes an acute or chronic condition that requires inpatient hospitalization. These conditions are also known as ambulatory care sensitive conditions (ACSCs).
A new study by Pracht and colleagues, including Farrokh Alemi, professor in the Department of Health Administration and Policy, shows that when nursing and primary care is delivered in shared private homes, avoidable hospitalizations are reduced. The study evaluated the Veterans Administration Medical Foster Home (MFH) Program, where a patient lives in a community home and VA delivers nursing and primary care to the patient. Patients who participate in the MFH Program had fewer instances of avoidable hospitalizations. The study was published in the American Journal of Medical Quality.
“When you are in a medical foster home, you are often the only one receiving nursing care there. Naturally, your host family eats with you, pays attention to you, monitors your medication, and interacts with you more than in a large nursing home,” Alemi said. “All this attention translates into fewer hospitalizations. You still have the same access to physicians, nurses, and other health professional as if you were in a nursing home, and now you have this host family that is caring for you as well. That makes the difference.”
The study analyzed VA MFH Program participants who had a verified medical history at least 180 days prior to and 180 days after enrollment in the VA MFH Program. MFH residents were compared to matched residents in VA nursing homes. Residents were matched on age, risk of mortality from their comorbidities, and history of hospitalization. The rate of avoidable hospitalizations was 18.5 per 100 participants prior to enrollment. After enrollment in the VA MFH Program, the rate of avoidable hospitalizations decreased to 14.9 per 100 participants.
“The results of our analysis support the idea that the number of complications and inpatient episodes caused by ACSCs can be reduced if ACSCs are managed and treated effectively in a small care environment,” Alemi said. “These types of care environments, such as the VA MFH Program, can improve the quality of care patients receive.”
The study is part of a larger effort by Cari R. Levy at Denver VA Medical Center. The larger research team includes investigators from DC VA Medical Center, Bay Pines VA Medical Center, University of South Florida, and three faculty members at George Mason University, including Alemi, Janusz Wojtusiak, and Phan Giang.