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Front-loaded Home Care and Office Visits May Reduce Heart Failure Readmissions

By Tinker Ready  
   August 11, 2016

A new study finds that front-loaded home care combined with physician office visits shows promise in reducing HF readmissions.

For years, hospitals and researchers have been searching for the right combination of care needed to prevent the readmission of heart failure patients. Still, a 2015 study found that only one in 70 hospitals has been able to bring the readmission rate for these complex patients below 20%. 

With penalties for readmissions rising, the search is still on. Options include better discharge planning, implantable pulmonary artery pressure monitors, and early, intensive home health care—often described as "front-loaded" care. 

And while better home health makes intuitive sense, its impact on readmissions has not been well-studied. Which is why researchers from the Center for Home Care Policy and Research in New York City decided to look specifically at heart failure readmissions of patient receiving follow-up home health care. They compared three interventions: early, intensive home health nursing; physician follow-up within a week; and a combination of the two.

The findings, published in the journal Health Services Research, suggest that neither intervention has much impact alone. But, the combination of a visit to the doctor and multiple home nursing visits in the week following discharge reduced the probability of readmission by roughly eight percentage points. That's a drop from approximately 20% of patients to roughly 12%. (However, the researchers note that the percent reduction could fall into a range between 4.1 to 12.3 points.)

The study validates the benefits of a specific approach to front-loaded care, said lead researcher Christopher Murtaugh, Associate Director, VNSNY Center for Home Care Policy and Research.

"There is very little research evidence to support [front-loaded care] despite the fact that the industry feels that it is likely to be important," he said.

Tinker Ready is a contributing writer at HealthLeaders Media.

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