Home-Based Primary Care for Older Adults: Matched Case-Control Evaluation of Program's Impact on Healthcare Utilization

Home-based Primary Care (HBPC) is an alternative model for homebound older adults. Healthcare utilization in HBPC was evaluated with a matched case-control design. Medical providers and social workers provided in-home visits. Enrolled patients were matched to controls on age, prior hospitalizations, and frailty risk. Difference-in-differences in utilization of primary care, specialty, and hospital services between 1-year pre- and 1-year post-enrollment were evaluated with hierarchical linear models. Analyses included 117 HBPC cases and 328 controls. HBPC cases had a significant increase in primary care visits compared to controls (7.8 +/- 0.6; p < .0001) but significantly decreased utilization of in-clinic primary care visits (-3.2 +/- 0.6; p < .0001). In-clinic specialty visits and hospital services did not differ between cases and controls (all p's >= .75). Homebound patients accessed high-touch primary and social care, which is typically unachievable in clinic settings; however, additional work is needed to optimize services and target in-home care to impact healthcare utilization.