Objective: To describe the structure and feasibility of an interdisciplinary home visit program (HVP) for homebound advanced Parkinson’s disease (PD) and related disorders.

Background: As PD advances, symptoms increase and individuals may become homebound, often losing access to neurologic care. This leads to a surge in acute care utilization and excess morbidity. Providing expert, in-home care may facilitate safer aging-in-place. In February 2014, we launched the Edmond J. Safra Interdisciplinary Home Visit Program for Advanced PD to provide comprehensive care and outreach to homebound individuals with PD and related disorders. Here, we present the model of care and retrospective analysis of all HVP patients seen through July 2016.

Methods: The HVP team, comprised of a movement disorders specialist, social worker, and nurse, worked with referring neurologists to identify patients with advanced parkinsonism. Patients living in New York City who met Medicare homebound criteria.  Referring neurologists deemed them to be at high risk for loss to follow-up, hospitalization, or institutionalization. Eligible patients agreed to a home visit by the HVP team including detailed history, examination, medication reconciliation, psychosocial evaluation, home safety assessment, and referral to in-home services. After each visit, a comprehensive interdisciplinary note was shared with providers, referrals made, and interim calls issued.  Patients could opt to continue receiving visits quarterly.

Results: We conducted 272 visits with 85 patients. Patients received a median of 3 visits (range 1-7). PD was the most common diagnosis (79%), followed by DLB and PSP (5% each), MSA (2%), and other atypical parkinsonism (9%). Women comprised 52% of patients; 7% each identified as African-American and Asian, respectively, and 15% identified as Hispanic. The mean total UPDRS at Visit 1 was 78 (SD 22) and median HY stage 4 (range 2-5). Patient and caregiver satisfaction demonstrated a ceiling effect; retention among eligible patients approached 100%.

Conclusions: We have demonstrated the feasibility of the HVP model to provide continuity of care to a vulnerable, diverse cohort of parkinsonian patients. Ongoing work includes the evaluation of drivers of care and implementation of telehealth as a step towards cost-effectiveness and dissemination.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-novel-model-of-care-for-advanced-parkinsons-disease-and-related-disorders-interdisciplinary-home-visits/