House Calls
Am Fam Physician. 2020 Aug 15;102(4):211-220.
The demand for house calls is increasing because of the aging U.S. population, an increase in patients who are homebound, and the acknowledgment of the value of house calls by the public and health care industry. Literature from current U.S. home-based primary care programs describes health care cost savings and improved patient outcomes for older adults and other vulnerable populations. Common indications for house calls are management of acute or chronic illnesses, coordination of a post-hospitalization transition of care, health assessments, and end-of-life care. House calls may also include observation of activities of daily living, medication reconciliation, nutrition assessment, evaluation of primary caregiver stress, and the evaluation of patient safety in the home. Physicians can use the INHOMESSS mnemonic (impairments/immobility, nutrition, home environment, other people, medications, examination, safety, spiritual health, services) as a checklist for providing a comprehensive health assessment. This article reviews key considerations for family physicians when preparing for and conducting house calls or leading teams that provide home-based primary care services. House calls, with careful planning and scheduling, can be successfully and efficiently integrated into family medicine practices, including residency programs, direct primary care practices, and concierge medicine.
House calls, also referred to as home visits, are increasing in the United States.1 Approximately 40% of patient visits in the 1930s were house calls.1,2 By 1996, this decreased to 0.5% because insurance reimbursements for house calls decreased.1,2 The pendulum in the United States is swinging again to house calls because of the need to develop care models for the growing aging population.1,3,4 The proportion of house calls to outpatient clinic visits conducted by family physicians in the United States is unlikely to reach the 1930s levels; however, the number of house calls conducted from 1996 to 2016 doubled.3 Medicare Part B billing and reimbursement for house calls are also increasing, with nearly 2.6 million house calls paid in 2015.5
WHAT'S NEW ON THIS TOPIC
House Calls
There were more than 1,100 direct primary care practices in the United States in 2019, and 68% of these practices offered house calls, including eight practices that were completely mobile (i.e., had no actual office).
A systematic review of nine studies (N = 46,156) evaluating home-based primary care outcomes for homebound older adults reported fewer hospitalizations, hospital bed days of care, emergency department visits, long-term care admissions, and long-term bed days.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
INHOMESSS = impairments/immobility, nutrition, home environment, other people, medications, examination, safety, spiritual health, services.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
Family physicians should refer eligible older adults with frequent hospitalizations to home-based primary care programs because of decreased hospitalization rates and 30-day hospital re-admissions.6–12 | B | Large-scale patient-oriented evidence including systematic review of observational studies and a randomized controlled |
References
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