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Home‐Based Primary Care Practices in the United States: Current State and Quality Improvement Approaches
Author(s) -
Leff Bruce,
Weston Christine M.,
Garrigues Sarah,
Patel Kanan,
Ritchie Christine
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13382
Subject(s) - staffing , medicine , family medicine , quality management , best practice , medical home , quality assurance , quality (philosophy) , odds ratio , medical record , population , nursing , medline , primary care , environmental health , operations management , management system , philosophy , external quality assessment , management , pathology , epistemology , economics , radiology , political science , law
Objectives To describe the characteristics of home‐based primary care practices: staffing, administrative, population served, care practices, and quality of care challenges. Design Survey of home‐based primary care practices. Setting Home‐based primary care practices in the United States. Participants Members of the American Academy of Home Care Medicine and nonmember providers identified by surveyed members. Measurements A 58‐item questionnaire that assessed practice characteristics, care provided by the practice, and how the quality of care that the practice provided was assessed. Results Survey response rate was 47.9%, representing 272 medical house calls practices. Mean average daily census was 457 patients (median 100 patients, range 1–30,972 patients). Eighty‐eight percent of practices offered around‐the‐clock coverage for urgent concerns, 60% held regularly scheduled team meetings, 89% used an electronic medical record, and one‐third used a defined quality improvement process. The following factors were associated with practices that used a defined quality improvement process: practice holds regularly scheduled team meetings to discuss specific patients (odds ratio ( OR ) = 2.07, 95% confidence interval ( CI ) = 1.02–4.21), practice conducts surveys of patients ( OR = 8.53, 95% CI = 4.07–17.88), and practice is involved in National Committee for Quality Assurance patient‐centered medical home ( OR = 3.27, 95% CI = 1.18–9.07). Ninety percent of practices would or might participate in quality improvement activities that would provide them timely feedback on patient and setting‐appropriate quality indicators. Conclusions There is a substantial heterogeneity of home‐based primary care practice types. Most practices perform activities that lend themselves to robust quality improvement efforts, and nearly all indicated interest in a national registry to inform quality improvement.