Integrating physician services in the home: Evaluation of an innovative program

Moira Stewart, John F. Sangster, Bridget L. Ryan, Jeffrey S Hoch, Irene Cohen, Carol L. McWilliam, Joan Mitchell, Evelyn Vingilis, Christine Tyrrell, Ian R. McWhinney

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

OBJECTIVE: To evaluate a new program, Integrating Physician Services in the Home (IPSITH), to integrate family practice and home care for acutely ill patients. DESIGN: Causal model, mixed-method, multi-measures design including comparison of IPSITH and non-IPSITH patients. Data were collected through chart reviews and through surveys of IPSITH and non-IPSITH patients, caregivers, family physicians, and community nurses. SETTING: London, Ont, and surrounding communities, where home care is coordinated through the Community Care Access Centre. PARTICIPANTS: A total of 82 patients receiving the new IPSITH program of care (including 29 family physicians and 1 nurse practitioner), 82 non-randomized matched patients receiving usual care (and their physicians), community nurses, and caregivers. MAIN OUTCOME MEASURES: Emergency department (ED) visits and satisfaction with care. Analysis included a process evaluation of the IPSITH program and an outcomes evaluation comparing IPSITH and non-IPSITH patients. RESULTS: Patients and family physicians were very satisfied with the addition of a nurse practitioner to the IPSITH team. Controlling for symptom severity, a significantly smaller proportion of IPSITH patients had ED visits (3.7% versus 20.7%; P = .002), and IPSITH patients and their caregivers, family physicians, and community nurses had significantly higher levels of satisfaction (P < .05). There was no difference in caregiver burden between groups. CONCLUSION: Family physicians can be integrated into acute home care when appropriately supported by a team including a nurse practitioner. This integrated team was associated with better patient and system outcomes. The gains for the health system are reduced strain on hospital EDs and more satisfied patients.

Original languageEnglish (US)
Pages (from-to)1166-1174
Number of pages9
JournalCanadian Family Physician
Volume56
Issue number11
StatePublished - Nov 2010
Externally publishedYes

ASJC Scopus subject areas

  • Family Practice

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    Stewart, M., Sangster, J. F., Ryan, B. L., Hoch, J. S., Cohen, I., McWilliam, C. L., Mitchell, J., Vingilis, E., Tyrrell, C., & McWhinney, I. R. (2010). Integrating physician services in the home: Evaluation of an innovative program. Canadian Family Physician, 56(11), 1166-1174.