Randomized controlled trial of a home-based primary care (HBPC) program shows some improved outcomes and contributes to evidence base on HBPC.
Homebound older adults have high rates of inpatient hospitalization and limited access to care. HBPC for homebound adults can improve access to care by bringing multidisciplinary teams and care coordination services directly to patients’ homes. This randomized controlled trial builds on prior evidence from observational studies that HBPC can improve health outcomes and reduce costs, and examines how participation in HBPC (as compared to office-based primary care) affects satisfaction with care, quality of care, symptom burden, and acute care utilization.
Patients in HBPC experienced higher satisfaction with care, higher rates of advance care planning, and lower hospitalization rates, but no differences in some other measures such as emergency department visits. The trial arm in HBPC has a higher mortality rate, which led to the study ending early and limited analyses of other date points. The authors offer one potential explanation as that HBPC is less aggressive care and may reflect the most appropriate care for patients with serious illness, though notes that additional evaluation is needed to determine the effects of HBPC.
While HBPC showed improved satisfaction of care and reduced hospitalizations for homebound older adults, it also was associated with increased rates of mortality. This study should be interpreted in the broader context of research on HBPC.