Frontloading is the practice of providing an increase in intensity of visits during the first two to three weeks of the home health care episode for patients that have been determined to be at high risk for hospitalization. Frontloading is also the practice of providing one visit in the first 24 hours of discharge from the hospital and a second visit or call within 48 hours of hospitalization. It is a systematic program to ensure that, when clinically appropriate, individualized patient plans of care contain increased visit frequency during the first two to three weeks of care.

Patients are at particular risk for adverse events and injuries in the period immediately following hospital discharge (Moore, et al., 2003) (Forster, et al., 2003). The first three weeks--and especially the first week--after admission to home care are the most critical. A quarter of unplanned hospitalizations for home health care patients occur within seven days of the start of their home health episode, and approximately 58 percent happen during the first three weeks of home health care (Crossen-Sills, et al., 2006).

Research in home health care supports frontloading (the practice of providing an increase in intensity of visits during the first two weeks of the home health care episode for high risk patients), especially for patients with heart failure (Rogers, et al., 2007) (Crossen-Sills, et al.) (The Delta Study to Reduce Hospitalizations, 2012).

Use the VNAA Blueprint to develop consistent frontloading processes incorporated with other best practices. See VNAA Blueprint modules on patient engagement; medication reconciliation; ensuring the patient has a physician appointment within seven days of discharge; and education about recognizing the signs that a condition is worsening.

How to use these resources:

Start with the training program, Frontloading - VNAA Best Practice for Home Health, which offers an overview of the resources available through the Frontloading best practice topic area.

The training program learning objectives are as follows:

• Identify three reasons that patients need frontloading.
• Identify two types of frontloading.
• Identify the criteria for patients to receive frontloading during the first two weeks of home care.