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Home-based nurse practitioners demonstrate reductions in rehospitalizations and emergency department visits in a clinically complex patient population through an academic–clinical partnership

Coppa, Denise PhD, FNP-C, FAANP1; Winchester, Suzy Barcelos MA1; Roberts, Mary B. MS2

Journal of the American Association of Nurse Practitioners: June 2018 - Volume 30 - Issue 6 - p 335–343
doi: 10.1097/JXX.0000000000000060
Quantitative Research

Background and purpose: The purpose of this pilot study was to describe the impact of one aspect of an academic–clinical partnership that showed how assigning nurse practitioner faculty to deliver home-based primary care services to clinically complex patients would decrease rehospitalizations and emergency department visit rates.

Methods: Rehospitalizations and emergency department visits of a cohort of 82 patients were recorded from April 15, 2016 to August 25, 2016 and compared with the same cohort during the two pre-home care inception periods (6 months and 1 year) using insurance claims–based data.

Conclusions: Compared with the 1-year pre-home care inception period, there was a decrease of 23.7% in emergency department visits and 34.9% decrease in rehospitalizations after the implementation of the home-based primary care program and a decrease of 35.6% in emergency department visits and 59.4% decrease in rehospitalizations compared with 6 months of pre-home care inception.

Implications for practice: Allowing nurse practitioners with full practice authority to deliver home-based primary health care services to homebound, chronically ill, recently discharged, and/or disabled patients can decrease costs and promote optimum health care in this population. In addition, these programs provide valuable learning experiences for nurse practitioner students and their preceptors.

1Graduate Program, College of Nursing, University of Rhode Island, Providence, RI,

2Memorial Hospital of Rhode Island, Center for Primary Care and Prevention, Pawtucket, RI

Correspondence: Denise Coppa, PhD, FNP-C, FAANP, University of Rhode Island College of Nursing, RI Nursing Education Center, 350 Eddy St, Providence, RI 02903. Tel: +1(401) 533-8567; +1(401) 874-9050; E-mail:

Authors' contributions: All authors have participated in the concept and design, analysis and interpretation of data, drafting and revising of the manuscript, and have approved the content of this report. Specifically, author contribution includes: D. Coppa conceptualized and designed the study, interpretation of data, reviewed and revised the manuscript, and approved the final manuscript as submitted. S.B. Winchester coordinated and supervised the data collection, drafted the initial manuscript, all revisions, and approved the final manuscript as submitted. M.B. Roberts performed all analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted.

Competing interests: The authors report no conflicts of interest.

Funding: This project was supported by the Health Resources and Services Administration (HRSA) under Grant number #D09HP28858, URI College of Nursing Academic Practice Partnership (Advanced Nursing Education). This information or content and conclusions are those of the author and should not be construed as the official position or policy or, nor should any endorsement be inferred by HRSA, or HHS or the U.S. Government.

Received January 29, 2018

Accepted March 01, 2018

© 2018 American Association of Nurse Practitioners
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