Study Explores Why Post-Discharge Home Nurse Visits Led to Increased Health Care Reutilization

Published September 2020 | Journal of Hospital Medicine

The intent of sending nurses on home visits after children are discharged from the hospital was to reduce the need for readmissions. But to the surprise of researchers tracking the Hospital to Home Outcomes (H2O) clinical trial, follow-up home nursing visits actually increased return visits to the hospital.

To better understand this outcome, a research team led by Sarah Riddle, MD, Katherine Auger, MD, and colleagues in the Divisions of Hospital Medicine, Patient Services, and General and Community Pediatrics, developed a qualitative study of key stakeholders in the H2O trial. Their findings shed light on why patients receiving nurse home visits were more likely to return to the emergency room, urgent care, or be readmitted to the hospital.

Researchers began by conducting focus groups and interviews with parents, primary care physicians, hospital medicine physicians, and home care registered nurses (RNs) involved in the trial. Next, a multidisciplinary team coded and analyzed the transcripts using an inductive, iterative approach to identify major and minor themes.

Several themes emerged. Informing families about “red flags” may have made families hypervigilant and more likely to seek further care, whether clinically indicated or not. Nurses also may have had a low threshold for escalating care, and their affiliation with the hospital made them more likely to direct families there instead of to a primary care physician.

Recommendations for improving the intervention included better communication between physician and nursing groups, individualization of home visits to specific patient needs, and providing more detailed context for “red flags.”

“Next, we aim to develop and optimize interventions to improve the transition from hospital to home for children with medical complexity and their families,” says lead author Riddle. “We are also working with families to adapt a patient-reported outcome measure of transition effectiveness for further study in a randomized controlled trial.”

Reasons for Hospital Returns and Suggested Improvements

This table shows the summary of major and minor themes by stakeholder type.