TY - JOUR
T1 - Home-based primary care practices in the United States
T2 - Current state and quality improvement approaches
AU - Leff, Bruce
AU - Weston, Christine M.
AU - Garrigues, Sarah
AU - Patel, Kanan
AU - Ritchie, Christine
N1 - Publisher Copyright:
© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - 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.
AB - 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.
KW - home-based palliative care
KW - home-based primary care
KW - house calls
KW - quality of care
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U2 - 10.1111/jgs.13382
DO - 10.1111/jgs.13382
M3 - Article
C2 - 25940131
AN - SCOPUS:84930005201
SN - 0002-8614
VL - 63
SP - 963
EP - 969
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 5
ER -