There is no one who will argue about the benefit of a home visit following a child’s hospitalization. It helps reinforce the discharge instructions and follow-up care and eases parental anxiety in coping following a hospitalization. Furthermore, we probably think such a visit will reduce reutilization of hospital services such as unplanned readmissions, a visit to the emergency department, or an urgent care visit. Well think again—or at least don’t miss a fascinating study by Auger et al. (10.1542/peds.2017-3919) that randomized 1500 previously hospitalized children to get either a single post-discharge nurse-led home visit within 4 days of discharge or no visit and then were monitored for 30 days to see if an unplanned reutilization visit to the health care system occurred. Interestingly, the children who got the one-time nursing intervention had much higher odds of wanting to visit an emergency department, urgent care center, or even be readmitted compared to those who did not get this intervention. In addition, after the home visit with a nurse, parents had better recall of symptomatic “red flags” warranting concern about their child’s health 14 days after discharge. So why is this happening when we might expect just the opposite (i.e. reassurance and less need to bring their baby into the health system environment) following a home visit?
We asked Vanderbilt pediatrician Dr. James C. Gay to weigh in with an accompanying commentary (10.1542/peds.2018-1190). Dr. Gay offers several hypotheses that might be at play as to why this intervention might have increased utilization ranging from different nurses than the floor nurses raising added concerns that were not shared during the hospitalization, or perhaps because the intervention patients were sicker than then control patients meaning the former group had more medical needs warranting additional attention from the health system (and yet the authors did try to control for similarity between groups). Since the study groups did not represent children with special or complex health needs, perhaps that subgroup would have decreased their reutilization rates because of the intervention more so than the non-complex children who participated in this study. While readmissions may not all be unwarranted, some are and should be prevented. Whether the readmissions in this study were or were not indicated is not the purpose of this intervention, nor does the study say don’t offer a post-discharge visit. Instead, utilize the findings in this study in terms of your own practice, and see what you can do to make your home visit program result in less utilization of hospital services post discharge.
