Ania Wajnberg

Hospitalizations and Skilled Nursing Facility Admissions Before and After the Implementation of a Home‐Based Primary Care Program

OBJECTIVES: To evaluate the effect of an urban house calls program (HCP) on healthcare utilization.

Reduction in Symptoms for Homebound Patients Receiving Home-Based Primary and Palliative Care

BACKGROUND Increasing numbers of patients are living with multiple, chronic medical conditions and functional impairments that leave them homebound. Home-based primary and palliative care (HBPC) programs provide access to health care services for this vulnerable population. Homebound patients have high symptom burden upon program enrollment. Yet little is known as to how individual symptoms are managed at home, especially over longer time periods. OBJECTIVES The purpose of this study was to determine whether high symptom burden decreases following HBPC enrollment. METHODS All patients newly enrolled in an HBPC program who reported at least one symptom on the Edmonton Symptom Assessment Scale (ESAS) were eligible for telephone ESAS follow-up. Patients received a comprehensive initial home visit and assessment by a physician with subsequent follow-up care, interdisciplinary care management including social work, and urgent in-home care as necessary. Multivariate linear mixed models with repeated measures were used to assess the impact of HBPC on pain, depression, anxiety, tiredness, and loss of appetite among patients with moderate to severe symptom levels at baseline. RESULTS One hundred forty patients were followed. Patient pain, anxiety, depression, and tiredness significantly decreased following intervention with symptom reductions seen at 3 weeks and maintained at 12 weeks. (p<0.01) Loss of appetite trended toward an overall significant decrease and showed significant reductions at 12 week follow-up. CONCLUSION In a chronically ill population of urban homebound, patient symptoms can be successfully managed in the home. Future work should continue to explore symptom assessment and management over time for the chronically ill homebound.

Symptom Burden in Chronically Ill Homebound Individuals

To document the degree of symptom burden in an urban homebound population.

Implementation Science Workshop: a Novel Multidisciplinary Primary Care Program to Improve Care and Outcomes for Super-Utilizers

San Francisco Department of Public Health, San Francisco, CA, USA; Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Social Work Services, Mount Sinai Medical Center, New York, NY, USA; Section of Hospital Medicine, Division ofGeneral InternalMedicineand Public Health, Department ofMedicine, Vanderbilt UniversityMedical Center, Nashville, TN, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.

Identifying Sociodemographic Characteristics Associated With Burden Among Caregivers of the Urban Homebound The Importance of Racial and Relationship Differences

Limited research has explored whether the burden associated with caring for homebound patients varies across racial groups or by relationship status. We examined these variations for this vulnerable population. Patients self-identified informal caregivers and caregiver burden/depression were assessed using the Zarit Caregiver Burden Scale and the Center for Epidemiologic Studies–Depression scale (CES-D). Forty-nine informal caregivers completed the interview. Mean age was 58 (SD = 14), 78% were female, 37% Black, 35% Hispanic, and 46% had completed high school. Over 60% of caregivers had moderate or severe caregiver burden and 30% had significant depression. White caregivers had greater burden than Black and Hispanic caregivers (p = .02). Mean caregiver burden was higher among spouse/partner caregivers, versus those who identified as children or other family or friends (p = .004). Additional research is needed to better understand the experience of racial and ethnic minorities and spouses in providing informal care to homebound adults.