First Advisor

Claywell, Lora

Second Advisor

Cullen, Patricia

College

Rueckert-Hartman College for Health Professions

Degree Name

Doctor of Nursing Practice

School

Loretto Heights School of Nursing

Document Type

Thesis - Open Access

Number of Pages

30 pages

Abstract

Problem: Many individuals who are disabled, homebound from chronic disease or are of advanced age have difficulty seeking medical services from an outpatient medical provider. Unnecessary or preventable hospital readmissions/ER visits from congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD) exacerbations are costly and these individuals would benefit from a house call program. The PICO format is as follows: P) Elderly and adult population with COPD and/or CHF. I) Adult and elderly population with COPD and/or CHF receiving house call visits by a nurse practitioner. C) Adult and elderly population with COPD and/or CHF receiving medical care at a clinic. O) Measurement of hospital admission and/or ER visits with those who receive house call visits compared to those who do not.
Purpose: To assess the efficacy of house call visits made by a nurse practitioner in seeing individuals with COPD and/or CHF compared to those who receive their care at a medical care clinic in determining if there a difference in the rate of hospital readmission and/or ER visits.
Goals: Providing in-home medical care to the adult and elderly population with chronic disease will decrease the strain in the medical clinics, ER and hospital systems by minimizing health exacerbations and these patients can remain at home.
Objectives: Comparing two groups of people with like-diagnoses of CHF and/or COPD to assess the benefit of receiving their health care at home versus those who receive their health care in a clinic.
Plan: 50 participants were selected ages 50 and over with CHF and/or COPD. Participants selected for this study were those who received a yearly physical exam from their insurance company and those who received home-medical visits from a house call provider group. 25 participants were selected for each group, those who received their medical care at a clinic and those who received their medical care at home. All the participants were seen in their home and were asked 3 questions. 1) Do you have COPD? 2) Do you have CHF? 3) Have you been in the hospital and/or ER in the last 12 months due to a CHF and/or COPD exacerbation? Their answers were documented on a context-specific data sheet. Those participants who answered yes to having COPD and/or CHF were selected for the study.
Outcomes and Results: Of the 25 participants who received their care at a medical clinic, 15 went to the hospital/ER in the last 12 months, totaling a hospitalization/ER rate of 65%. Of the 25 participants who received their care at home, 8 went to the hospital/ER in the last 12 months, totaling a hospitalization/ER rate of 35%. The results showed that those participants who received home medical visits by a nurse practitioner had a decrease in medical exacerbations resulting in a hospitalization/ER visit compared to those participants who received their care at a medical clinic. House call visits are beneficial in providing a cost-effective medical care model that support those with chronic illness in being able to remain in their homes.

Date of Award

Spring 2016

Location (Creation)

Colorado (state); Denver (county); Denver (inhabited place)

Rights Statement

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