URI study: Nurse practitioner home visits correlate to big drop in hospital admissions, ER visits

Results cited as College of Nursing awarded final year of funding for $1.6-million federal grant

KINGSTON, R.I., July 18, 2017 —Hospitalization rates plummeted 61 percent, and emergency room visits fell 64 percent among a group of patients who received home visits from nurse practitioners and graduate students during a six-month period in 2016, according to a University of Rhode Island College of Nursing study.

The home visits to financially disadvantaged patients with chronic health issues were part of a three-year, $1.6 million grant from the U.S. Public Health Service’s Health Resources and Services Administration (grant number D09HP288558) awarded to URI Nursing Professor Denise Coppa in 2015. The project established academic and clinical partnerships with Providence Community Health Centers and Thundermist Health Centers in Rhode Island to advance nursing practice and improve patient outcomes through enhanced primary care for the medically underserved.

For the home visit component, nurse practitioners from Thundermist and nurse practitioner students from URI visited 82 patients over a six-month period in 2016, recording health data that included hospital admissions and emergency room visits. At the end of the six-month period, in fall 2016, researchers compared their findings to data from the same group of patients during the six-months prior to the home visits. The analysis revealed the marked improvements in outcomes. “Same exact people, same health centers, same period of time,” Coppa said.

The grant requires that URI demonstrate results, and the significant findings from the home visit study helped URI secure $700,000 in funding for the final year of the project, Coppa said. In addition, based on these findings, Thundermist plans to continue its home visit program, she said. The project team also is analyzing state records regarding emergency room and hospitalization costs for the general population to determine the potential economic benefit from such visits and their impact on hospital visits. “The savings could be significant,” Coppa said.

The project, which provides clinical training and mentoring under licensed health center nurse practitioners who are URI faculty, examines clinical mentor impacts on student and professional learning. Enhanced training for nurse practitioner students, and their preceptors, could improve delivery of primary care across the state, Coppa said. Licensed primary care nurse practitioners in Rhode Island are fully authorized to diagnose and treat acute and chronic health conditions; order, perform and interpret diagnostic tests; write prescriptions; and manage overall patient care. In these roles, nurse practitioners can help ease the shortage of primary care health providers, which leaves 67 percent of care needs unmet in Rhode Island, according to the Health Resources and Services Administration.

The URI-led project is helping address this need by preparing more than 100 family nurse practitioner and adult/geriatric nurse practitioner students at the master’s or doctoral level over three years. Since the project began, URI has nearly doubled enrollment in its nurse practitioner programs, from 55 students in 2016 to 99 in 2017, Coppa said. The community health center partnerships provide much-needed clinical placement opportunities, allowing the enrollment expansion, Coppa explained. URI also increased program enrollment of ethnically diverse or disadvantaged students from 21 percent in 2015 to 28 percent in 2017, exceeding the project goal of 25 percent, she said.