Agency approaches to common quality problems in home care: a scenario study

In a study of best practices in home care quality assurance (QA), a sample of 128 respondents from exemplary home care agencies were presented with 7 brief scenarios depicting common problems in home care quality. Agency respondents were asked to describe their likelihood of identifying the problem in each scenario, how they would identify the problem, and how they would correct it. We found that agencies expressed considerable confidence they would identify the problems, but were unlikely to view their QA efforts as contributing to detecting the problems. Identification was more often perceived to come from ordinary care, with considerable burden placed on paraprofessional staff or clients to bring the problem to the attention of the agency. Medically-oriented agencies were significantly more likely than socially-oriented to rely on formal QA to identify deteriorating patient conditions and depression. Across all agencies, a relationship existed between the type of problem in the scenario and the most frequent responses about detection and correction nodes. Once the problem was identified, agencies presented an appropriate and fairly wide range of corrective strategies. The implications for making QA more organically related to clinical care are discussed.