The participants were assigned to home visit protocol by the researchers prepared the team before the home visit. First, we set of plans and objectives for the visit. Second, we studied the economic and social structures of the community and collected the patient’s medical and family history documents (family folder). Lastly, we did personal preparation such as knowledge, medications, needed equipment, and first aid. During home visits, in order to build trust and relationships for holistic service, the team leader (surgeon) assessed each patient and their family by using the guideline INHOMESSS [
14‐
16]. The following terms were defined: I = immobility. Evaluates whether the patient can take care of themselves or do they need the help of others. We evaluated the patient’s functional activities including an assessment of daily living activities (bathing, transfer, dressing, using the toilet, eating, continence) and instrumental activities of daily life (using the telephone, administering medications, paying bills, shopping for food, preparing meals, doing housework). We asked the patient to demonstrate elements of their daily routine, such as getting out of bed, performing personal hygiene and leisure activities, and getting in and out of a car. Corrective interventions were directed for any noted deficiencies. We assessed the activities of daily living such as using the shower or toilet, dressing, and doing other instrumental activities of daily living. N = nutrition of the patient. Food affects health directly especially for the elderly. We assessed the patient’s current state of nutrition, eating behaviors and food preferences. We started by always asking open-ended questions. For example, “We have been working hard on your diet to control your diabetes. Would you remember the types of foods you eat?” Improvements in cooking materials allowed the physician to assess serving sizes and the nutritional value of foods with relative ease. We also asked questions like, “How many meals do you have per day?” H = home environment. The environmental factors that affect the patients and their families, such as the presence of stairs in the house, whether the bedroom was located upstairs or downstairs, and whether the toilet seat was high or low. The patient’s home environment should allow for privacy, social interaction, and both spiritual and emotional comfort and safety. Important for many older patients is the presence of a safe neighborhood with close proximity to services. The home may reflect the living condition of patients and their families, such as the presence of stairs in the house, the location of the bedroom upstairs or downstairs. O = other people. The relationships within the family. Whether the patient lives alone or with relatives. Also the presence of neighbors who help the patient. By having the patient’s social support system during the home visit, we clarified the roles and concerns of family members. We assessed the availability of emergency help for the patients from family members and their friends and clarified specific issues, such as who is to serve as a surrogate for the patient in the event of incapacitation. Discussion of a living will be more comfortably performed during a home visit than during a clinic visit. Also critically important is the evaluation of the caregiver’s needs and their risk for burnout. M = medications. This factor deals with the history of how the patient takes their medication, their self-reliance and their discipline. To remedy or avoid polypharmacy, we evaluated the type, amount and frequency of medications, and the organization and methods of medication delivery. An inventory of the patient’s medicine containers can provide clues to previously unidentified drug-drug or drug-food interactions. A home medication review can also allow a direct estimate of patient compliance. E = examination. This factor includes physical examination such as blood pressure measurement, wound care, and signs of complications. We did a directed physical examination based on the needs of the patient and the physician’s agenda. We asked the patient to demonstrate proper techniques for walking with or without gait aid. In addition, we can weigh the patient and obtain a blood pressure measurement. In-person correlation of home and office measurements provides useful information aiding in future telephone and clinic contacts. S = spiritual. Health beliefs, attitudes, values, culture, traditions, and psychosocial factors of the patient and their family. We asked about the influence of spiritual beliefs on the patient’s sense of physical and emotional health. This information may provide the impetus, as desired by the patient, for a discussion of spirituality as a coping and healing strategy. S = service. Evaluation at home for available health services for the patient and their family. S = safety. Safety assessment of the home atmosphere. The goal of the home safety assessment is to determine whether the patient’s environment is comfortable and safe (no unreasonable risk of injury). We identified and helped modify potential safety hazards. After each home visit, we collected all data by using the home visit form. This can be used to track data for an improvement of the quality of service. In our study, we used the same discharge preparation protocol for both groups including wound care education, wound management, home medication, and home-based rehabilitation such as range of motion exercises, using a gait aid, and quadriceps exercises.