Assessing quality in home-care programs

As the chronically homebound population increases, more primary-care individuals and groups will be providing care in the home. Assessing and improving the care of this population involves developing strategies to monitor the quality of care provided (for example, using clinical practice guidelines), assessing the efficacy of plans to help prevent decline, and identifying unavoidable negative outcomes. Outcome indicators for this group must be able to discriminate between expected decline and decline that could have been modified by medical intervention. Because of multiple variables not present in institutional settings, in-home care presents a somewhat different situation than care of nursing home residents.