FeatureHome Healthcare Nursing Visits for Nonhomebound Patients With Heart Failure After Hospital Discharge A Quality-Improvement Pilot ProjectKang, Youjeong PhD, MPH, CCRN; Mondesir, Favel L. PhD, MSPH; Young, Dawn BSN, BA, RN; Norris, Eddie BS, JD, LLM; Hernandez, Juan M. MSN, RN; Nativi-Nicolau, Jose MD; Stehlik, Josef MD, MPHAuthor Information Youjeong Kang, PhD, MPH, CCRN, is an Assistant Professor, Health Systems & Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah. Favel L Mondesir, PhD, MSPH, is a Postdoctoral Research Associate, Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah. Dawn Young, BSN, BA, RN, is an Operational Manager–Cardiology, University of Utah Health, Salt Lake City, Utah. Eddie Norris, BS, JD, LLM, is Managing Partner, Canyon Home Care and Hospice, Salt Lake City, Utah. Juan M. Hernandez, MSN, RN, is Senior Nursing Director, Post Acute Care Collaborative, General Inpatient Hospice, Nursing Leadership Principles, Salt Lake City, Utah. Jose Nativi-Nicolau, MD, University of Utah School of Medicine, Salt Lake City, Utah. Josef Stehlik, MD, MPH, is a Christi T. Smith Professor, University of Utah School of Medicine, Salt Lake City, Utah. The authors declare no conflicts of interest. Address for correspondence: Youjeong Kang, PhD, MPH, CCRN, 10 South 2000 East, Salt Lake City, UT 84112-5880 ([email protected]). Home Healthcare Now: January/February 2021 - Volume 39 - Issue 1 - p 25-31 doi: 10.1097/NHH.0000000000000925 Buy Metrics Abstract Frequent rehospitalizations among patients with heart failure (HF) result in patient burden and high cost. Homebound patients with HF qualify for home healthcare after hospital discharge. It is not known if nonhomebound patients with HF could also benefit from home healthcare nursing (HHN) visits to improve the transition from hospital to home. The purpose of this quality-improvement pilot study was to assess the impact of HHN visits provided to nonhomebound HF patients after hospital discharge on 30-day rehospitalization rates. We included patients with HF who were ineligible for home healthcare services due to their nonhomebound status. Home healthcare nurses followed a modified version of the discharge checklist from the American Heart Association's Rise Above Heart Failure materials, and provided education as appropriate based on patients' responses. We enrolled 68 patients in the study. The mean age was 60.2 years; 61.8% were male and 77.9% were White. Based on patient responses to the checklist, key areas addressed during HHN visits were medication management and HF self-care. In the HHN visit group, 15% of the patients experienced rehospitalization within 30 days, compared with 23% in the non-HHN visit group among 540 patients discharged in the same time frame who met the inclusion criteria but were not enrolled in the study (p = .12). Our pilot data show that HHN visits for nonhomebound patients are feasible and result in a numerically lower 30-day rehospitalization rate after discharge. Further study is needed to confirm the clinical efficacy of this approach. Wolters Kluwer Health, Inc. All rights reserved.