House-call model tapping interventional radiology improves outcomes and access to care

"Older homebound patients, including those in nursing home settings, have few resources available to receive specialty care and often delay care until preventable issues become urgent and acute," said Nazar Golewale, MD, lead author of the study and an interventional radiologist with Modern Vascular & Vein Center in Valparaiso, Indiana and the northwest Indiana area. "By providing image-guided treatments in a patient's home, we are improving access to care that otherwise would need to be delivered in the hospital."

Dr. Golewale sees more than 900 of the practice's patients to diagnose and manage their conditions. Through varieties of portable technology, he brings interventional radiology care into patients' homes that would normally be delivered in clinics, such as ultrasound-guided needle biopsy, paracentesis and thoracentesis, ultrasound-guided joint injections for pain, wound care, and drug infusions. Payments for care are covered by Medicare reimbursement for homebound patients.

The care partnership was formed to overcome the difficulty of providing specialty care for chronically ill, homebound patients in Dr. Golewale's rural community. As a result of the program, patient satisfaction scores increased from 17 percent to 84 percent from before and after implementation of the program. Primary care providers, including internists and nurse practitioners, recruited specialists based on the needs of the patients they serve. In addition to interventional radiology, the house call practice includes providers in internal medicine, podiatry, laboratory services, and wound care.

"Some specialty services are available at our local hospitals, but cost-effective ways of coordinating patients' transportation and visits remained a significant barrier to care," said Golewale. "By bringing the hospital care to the patient, we're eliminating these hurdles and providing timely, personalized care."