Experience with Home Care for Cardiac Patients

Abstract

A group of 55 patients with severe cardiac disease were provided with intensive home medical care following discharge from the hospital during the 2-year period beginning July, 1952. At the same time, a comparable group of 35 patients were followed without home care services as a control. Through a study of medical care needs of these patients, it was hoped to: (1) clarify some confusion that exists in relation to cost of home care services; (2) indicate whether availability of a home care program is associated with significant alteration of rate of utilization of other medical care facilities, particularly hospitals; (3) emphasize nature and extent of services required by such patients in terms of clinical, social, and community activity; and (4) demonstrate degrees of clinical, social, and community coordination that are required in order to provide continuous and integrated patient care. Results of the study suggested that, because of multiplicity of diseases in this group of patients, there was little justification for limitation of services to disease categories. The amount of associated disease indicates that comprehensive medical care programs increase the variety of services needed by patients similar to those in the study group. Despite low income and serious housing problems, all but 2 patients were cared for in their own homes; however, over 30 social and health agencies were involved in providing care for patients in the study group. Rate of hospitalization for cardiac disease was markedly reduced in the study group as compared with the control group. Presence of multiple concomitant disease, however, results in an increase of hospitalization for non-cardiac disease. As a result, the final rate of hospitalization was essentially the same but for different causes. It was felt that comprehensive care involves a qualitative as well as a quantitative increase in services; provision of home care for older and chronically ill patients, therefore, introduces an additional cost which can be justified only on the basis of better and more effective service.