Resources: Frontloading

VNAA Best Practice:

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. 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.

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.

Rogers et al., found that for patients with heart failure, providing 60 percent of visits in the first two weeks decreased hospitalization rates by half, from 39 percent to 16 percent. This result was achieved with fewer visits overall. 

Crossen et al., found that with multiple strategies and interventions, including frontloading and telemonitoring, heart failure and chronic obstructive pulmonary disease (COPD) patients showed a 2.6 percent decrease in unplanned hospitalizations over a six-month period.

In the Delta Study to Reduce Hospitalization (2012), frontloading was used frequently by many successful agencies, with the most successful agencies using strategies such as a 24-hour response service, telephonic protocol, formal hospitalization reduction training and a risk assessment strategy used at intake.   

High risk patients are those at risk for hospitalization, including heart failure and COPD patients, as well as those patients on high risk medications.  

Helpful Hints and Other Tools

• Practice change should be monitored closely by supervisory staff until implemented and well established.
• Schedulers should be trained and monitored until frontloading is implemented and well established.
• Telemonitoring or telephone protocols can be helpful, but track them separately in order to evaluate their impacts.

Frontloading References