Physician assistant home visit program to reduce hospital readmissions

Abstract

Objective: A physician assistant home care (PAHC) program providing house calls was initiated to decrease hospital readmission rates. We evaluated the 30-day readmission rates and diagnoses before and during PAHC to identify determinants of readmission and interventions to reduce readmissions.

Methods: Patients who underwent cardiac surgery were evaluated postoperatively for 13 months as pre-PAHC (control group) and 13 months with PAHC. Physician assistants made house calls on days 2 and 5 following hospital discharge for the PAHC group. Both groups were seen in the office postoperatively. We retrospectively reviewed the charts of 26 months of readmissions. Readmission rates for the control and PAHC groups were compared, as were the reasons for readmissions. Readmission diagnoses were categorized as infectious, cardiac, gastrointestinal, vascular, pulmonary, neurologic, and other. Also noted were the interventions made during the home visits.

Results: There were 361 patients (51%) in the control group and 340 patients (49%) in the PAHC group. Overall readmission rate for the control group was 16% (59 patients) and 12% (42 patients) for the PAHC group, a 25% reduction in the rate of readmissions (P = .161). The rate of infection-related readmissions was reduced from 44% (26 patients) to 19% (8 patients) (P = .010). Home interventions included adjustment of medications (90%), ordering of imaging studies (7%), and administering direct wound care (2%).

Conclusions: The 30-day readmission rate was reduced by 25% in patients receiving PAHC visits. The most common home intervention was medication adjustment, most commonly to diuretic agents, medications for hypoglycemia, and antibiotics.