Physician assistant home visits significantly reduce hospital readmissions after heart surgery

"Adult cardiac surgery has one of the highest readmission rates for all hospitalized patients," said John P. Nabagiez, MD, from Staten Island University Hospital in New York, who led the study. "Our study was designed to determine if two home visits by a physician's assistant could help reduce readmission rates following heart surgery."

Dr. Nabagiez and colleagues analyzed hospital readmission rates of 1,185 patients who underwent cardiac surgery from September 2008 through August 2012 at Staten Island University Hospital in New York. Patients were divided into those who received home visits and those who did not receive visits (control group). Readmission rates, lengths of stay, and healthcare costs were compared between the two groups.

The patients who received visits from PAs on days 2 and 5 following hospital discharge had a significantly lower rate of readmission (10%) compared with those who did not receive home visits (17%). This represents a 41% reduction in the rate of readmission within the first 30 days following cardiac surgery.

"The physician's assistants who made the house calls in our study were fully trained cardiac surgery PAs who were actively involved in the preoperative, intra-operative, and postoperative care of our patients," said Dr. Nabagiez. "Unlike standard visiting nurses, our PAs knew each patient personally and understood all of the pertinent issues of the patient's medical history. They also knew the patient's individual postoperative course prior to discharge, so they entered the patient's home already knowing the concerns, if any, of the surgeon and the patient."

The analysis also showed an overall reduction in healthcare expenditures during the course of the study. It cost $23,500 to make house calls to 363 patients, which saved $977,500 in readmission costs. This translated to $39 in healthcare savings for every $1 spent.

"It is essential for patients to comply with all prescribed medications and physical rehabilitation after heart surgery, and two house calls in the first week after discharge helped patients remain focused on these goals," said Dr. Nabagiez. "Complications can arise in the first week after surgery, and these initial home visits can help diagnose problems earlier, which can keep patients out of the emergency department. We found that making these two visits is cost effective and keeps patients on the road to recovery, while also reducing hospital readmissions."