3 Reasons to Conduct Home Visits for Medically Complex Patients

Wednesday, August 11th, 2010
This post was written by Jessica Fornarotto

Jessica Simo, program manager with Durham Community Health Network for the Duke Division of Community Health, maps out three reasons why home health visits can reduce unnecessary utilization.

The Durham Community Health Network is a primary care case management program for Medicaid recipients who live in Durham County. We are responsible for over 22,000 covered lives in the Medicaid program and home visits were not necessarily something new for our program. Since the inception of the program in 1998, it is something that we have done to better address the needs of the Medicaid recipients and link them to their medical homes. However, home visits were vital to the pilot program and were done in a more structured way than our program had done previously. The Care Partners patients who were selected for the pilot received home visits at least once a week in the first phase of the pilot project. That is something we monitored vigorously in our weekly multidisciplinary meetings.

Why are home visits so important? Number one, it is very challenging to observe problems that individual patients may have with adhering to their medication regimens if you can’t see the medicines in the bottle in the patient’s home. You need to be available to count the medicines and ascertain definitively that they are not missing. Trying to do medication reconciliation over the phone is nowhere near as effective as being in a patient’s home.

Another reason home visits are more effective is that you can physically see what activities of daily living (ADL) or instrumental activities of daily living (IADL) deficits the patient may be experiencing in their natural environment. This is something you can’t directly observe within the confines of an exam room.

The engagement of family or their other support persons is also important. Home visits are an excellent way to see somebody in their natural environment, find out who the support people are for the patient, have a comfortable discussion in their home about an individual plan of care and get the people who can assist with that on board.

For all of the previous reasons, home visits were critical to the pilot. It’s especially important in a medically complex patient population where there are frequent transitions, whether those be from the acute care setting, from any ED visit or back into the home from an assisted living facility.

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