Making Modern House Calls to Improve Patient Care

As opposed to the general-purpose house call of the past, contemporary house calls can generate targeted benefits such as hospital readmission reductions.

Opportunity is knocking for physicians willing to make house calls.

Carefully targeted house calls can reduce patient anxiety, decrease hospital readmissions, improve patient safety, and increase physician familiarity with patients, says William Frishman, MD, of New York Medical College and Westchester Medical Center in Valhalla, New York.

"People spend more time at home than they do in a hospital or a clinic. You really have to see what their living conditions are like. It helps with the long-term care of the patient," Frishman says.

"When heart attack patients go home from the hospital, they are scared stiff. The husband or the wife doesn't know how to handle it. Having a doctor come to the home is extremely reassuring," he says.

Beyond reducing patient and caregiver anxiety, research published by The Journal of Thoracic and Cardiovascular Surgery has shown that house calls can effectively reduce 30-day hospital readmissions for cardiac surgery patients.

The research found that a physician assistant home care program including house calls reduced the 30-day readmission rate by 25%. The most common house call intervention was medication adjustment.

Another study found that house calls are a crucial component of managing care and boosting care quality for geriatric patients who are homebound.

Assessing patient safety should be a primary house call objective for physicians and nurses, Frishman says.

"Older patients in the home should not have to bend down to get something. They should not have to get up on a stool to get a dish. Everything should be at a level where the patient does not have to go up or bend over."

Physicians can learn essential information about their patients during house calls, he says.

"Unless you have a sense of what is happening in the home, you are missing something in your relationships with patients. … When I see them in the office later, I know the patients better. House calls give you another look at how the patients are doing."

Patient selection
 

Physicians need to make judgment calls when deciding which patients are most appropriate for house calls, Frishman says.

"If someone is having chest pain, you wouldn't make a house call. You would tell them to get to an emergency room. The traditional house calls from 50 years ago are different from house calls today. Part of today's house call is finding ways to keep people from coming back to the hospital."

Selecting patients for house calls must be an individualized process, he says.

"There is not the universal, middle ground patient. Even in the middle ground, there are some patients you will send to the hospital and others you can wait to see until the next day. It relates to your experience with the patient and your judgment. For new patients, I generally would not go to the house. I would tell them to come to the office or to the hospital."

In a recent article published in The American Journal of Medicine, Frishman described the four kinds of house calls he makes:

• Post-heart attack visit: For patients who have had their first heart attack, Frishman makes a house call about a week after hospital discharge. In addition to addressing patient and caregiver anxiety, these visits focus on medication reviews, care-related questions, and a walk with the patient.
   
• Post-heart failure visit: After hospitalization for heart failure with or without a heart attack, Frishman's house calls focus on medications, diet, and body weight. As is the case with heart attacks, he takes a walk with the patient.
   
• Geriatric visit: For new geriatric patients, Frishman makes house calls for homebound people. The primary goals of these visits include assessing fall risks and getting to know the patients more completely through observations in the home setting.
   
• Post-funeral visit: After a patient's death, Frishman makes a house call to the family a few days later to help avoid years of psychopathology among the survivors. The primary objective of these visits is to reassure family members that they are not to blame for the loss of their loved one.