The following article is a part of conference coverage from the 2021 American Association of Nurse Practitioners National Conference (AANP 2021), held virtually from June 15 to June 20, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading NPs. Check back for more from AANP 2021.
For chronically ill, home-based patients, telephone access to nurse practitioners (NPs) is associated with decreased emergency department (ED) visits, according to findings presented at the 2021 American Association of Nurse Practitioners National Conference (AANP 2021).
The availability of federal funding has allowed for the development of academic-clinical partnerships between NP education programs and community-based clinical agencies, noted Denise Coppa, PhD, FNP-C, FAANP, FAAN, and colleagues. These academic-clinical partnerships contribute to value-based health care models — like NP-led home-based primary care programs — that improve patient outcomes, decrease hospital and ED admissions, and decrease health care costs in homebound patients living with multiple chronic illnesses and/or disabilities.
Dr. Coppa and colleagues were part of an academic-clinical partnership between the University of Rhode Island College of Nursing and local community health centers. The community health partner was an HPSA-designated federally qualified health center that served 3 communities as a patient-centered medical home, providing care to over 51,000 medically underserved and disadvantaged patients.
Through the initiative, the researchers studied the value of telephone encounters and the effect that these calls have on patients. Patient data were collected between April 15, 2016 and June 30, 2018 and compared with 2 periods before home-based primary care (April 1, 2015, to September 15, 2015, and November 1, 2015 to March 31, 2016). Electronic medical records were reviewed for data on hospitalizations, ED visits, and telephone encounters for all 3 periods.
Chronically Ill Cohort
Patients with chronic conditions including diabetes, congestive heart failure, COPD, asthma, hypertension, and psychiatric illnesses were included in the study cohort; these patients were considered high risk and high utilizers, and generally had barriers to accessing care in clinic settings because of mobility challenges or major illnesses. The patients in the study also had 3 or more ED visits or hospitalizations within the previous 6 months.
The cohort included 157 patients (mean age, 63.5±14 years; 90% White; 69% women). Within this cohort, 98% of patients had difficulty accessing health care, 54% were on Medicare, 21% were on Medicaid, and 1% were uninsured.
Although patients with 4 or more telephone encounters had an increased number of ED visits during the home care intervention, these patients were likely the most medically compromised, the authors noted (Figure). This increase was offset by a decrease in ED visits among patients with 1 to 3 telephone encounters. The overall number of ED visits was decreased by 13% (P =.03) with each 1-unit increase in the number of telephone encounters for patients with hypertension, diabetes, heart disease, dyslipidemia, and arthritis, the researchers reported.
The number of hospitalizations decreased in all patients regardless of the number of telephone encounters; however, this difference did not reach statistical significance.
“Emergency department visits are probably the most expensive form of primary care,” said Mary Koslap-Petroco, DNP, PPCNP-BC, CPNP, FAANP, clinical assistant professor at Stony Brook University School of Nursing in Stony Brook, New York. “Providing NPs with a cost effective, easy to use, telephone model to decrease recidivism provided positive outcomes for both the patient and the health care system. Medical homes and appropriate follow-up are an evidence-based approach to providing the support patients need to decrease repeated ED visits,” she said.
“Federal support for academic-community partnerships imports potential for improved patient outcomes, decreased ED visits and hospitalizations, and health care costs,” the researchers concluded. Telephone encounters by NPs with home-based primary care “patients are necessary and worthwhile.”
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Coppa D, Winchester SB, Roberts MB, Maestri X. Analysis of telephone encounters in a home-based primary care program results in a decrease in emergency department visits. Presented at: 2021 American Association of Nurse Practitioners National Conference; June 15-20, 2021. Poster 83.