Gray's house call program continues to grow

Sunday, November 10, 2019

Back in 2017, Dr. Nathan Gray jumped in to help kickstart a novel palliative care house calls program. The vision was to create a program that would meet the needs of seriously ill patients, those not yet ready for hospice, but who had a limited prognosis and a substantial need for goals of care conversations and symptom management. Dr. Gray took the initiative and began to use his administrative time to do home visits of patients who were referred by the palliative care team, mostly following hospital discharge.

This house calls program effectively demonstrated a 50% reduction in hospitalizations and a large increase in hospice referrals compared to a control group. The program has grown rapidly and has continued to show a decrease in acute care utilization as well as more, and earlier, hospice referrals. 

"The house calls program has been a wonderful addition to our toolbox in reaching patients who are wrestling with advanced illness," says Dr. Gray.

This program provides focused, consultative palliative care in the home for patients who are physically unable to make it to an outpatient clinic. They now have a full-time nurse practitioner, Kerrith McDowell, who sees patients both at home and at select skilled nursing facilities. 

"While we are still in the early phase of data collection, we are seeing a significant reduction in hospital re-admissions, and the availability of in-home consultation has been warmly welcomed by patients who struggle with leaving their house," explains Gray.

The team is currently seeing patients in the counties of Durham, Wake, and Orange with the hopes of growing to reach patients in multiple sites. 

Dr. Nathan Gray is an Internal Medicine and Palliative Care Specialist at Duke. Follow him on Twitter @NathanAGray