Physician House Calls Cost-Effective in the Elderly

Laurie Barclay, MD

May 16, 2003

May 16, 2003 — Physician house calls reduced hospitalizations, length of stay, and emergency department visits, and they may be financially favorable, according to the results of a randomized controlled trial presented at the American Geriatrics Society 2003 Annual Scientific Meeting on May 16 in Baltimore, Maryland.

"Physicians should feel empowered by these financial facts as they seek support for house calls from sponsoring hospitals," lead author Ziad R. Haydar, MD, from Baylor Health Care System in Dallas, Texas, told Medscape. "Before this study, the financial impact on the sponsoring hospital was unknown."

Between July 1987 and January 2002, 432 homebound subjects 65 years or older were randomized to receive six months of either usual care or interdisciplinary house calls from a team of geriatricians, nurse practitioners, a social worker and a chaplain, coordinated by a weekly team meeting. Subjects receiving hospice services or awaiting nursing home admission were excluded. Both groups were similar in terms of demographic variables, and both had significant cognitive and functional impairment.

During the six-month study, there was no statistically significant difference in admissions to the sponsoring hospital (55 from the home visit group and 44 from the control group). Emergency department visits were significantly less in the home visit group (0.12 vs. 0.24 per subject; P = .016). Average length of stay was 5.64 days in the home visit group and 8.48 days in the control group (P < .001). The shorter length of stay was associated with a margin of $934 compared with a loss equal to $1,576 for the longer length of stay in the control group.

"All hospitals are struggling to survive shrinking Medicare reimbursement," Dr. Haydar said. "At the same time, sometimes for the right reasons and sometimes for the wrong reasons, they are trying to identify strategies to maximize care to their seniors. Sponsoring house calls is one strategy that could help accomplish both goals."

The Merck Foundation helped support this study indirectly through research funding of related projects. The authors list no pertinent financial disclosures.

AGS 2003 Annual Meeting: Abstract A21. Presented May 16, 2003.

Reviewed by Gary D. Vogin, MD