Evaluation of Hybrid-Virtual Home Visits for Comprehensive Geriatric Management: A Quality Improvement Project.

Abstract

Although home visits improve outcomes among older adults, expanding the reach of geriatric home-based programs has been constrained by physical, cognitive, and technological barriers common among older persons as well as facility barriers (e.g., limited staffing). To evaluate the effectiveness of a hybrid-virtual home visit model (TeleGRACE). A quality improvement project with an observation cohort design using propensity score weighting. Community-dwelling older adults with a geriatric syndrome after discharge from a hospital stay or emergency department (ED) visit at one large Department of Veterans Affairs (VA) facility. A hybrid-virtual home visit involving a telehealth technician in the patient's home and geriatric clinical team members participating remotely. The primary outcomes were all-cause mortality, nursing home placement, inpatient readmission, and ED visits within 90 days or 1 year of enrollment. TeleGRACE patients (N = 76) were more likely than usual care patients (N = 319) to receive clinical services within 90 days (e.g., assistive devices: 78.7% versus 18.9%; p < 0.001). In analysis using inverse probability weighting, the 1-year risk of nursing home placement was lower in TeleGRACE than in usual care: hazard ratio (HR) 0.20 (95% CI: 0.07-0.53). The risk of ED visits was higher among TeleGRACE patients both at 90 days (HR 1.32 [1.02-1.72]) and 1 year (HR 1.28 [1.04-1.76]). No differences between groups were identified for nursing home placement at 90 days, or hospitalizations or mortality at 90 days or 1 year. The results indicate that a hybrid-virtual home visit model may improve care and outcomes for high-risk, community-dwelling older persons; future studies are needed to confirm whether this model reduces nursing home placement.