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Published on: February 16, 2011
Brief communication: National quality-of-care standards in home-based primary care
Kristofer L Smith1, Theresa A Soriano, Jeremy Boal
1the Mount Sinai School of Medicine, New York, New York.
Background:
Home-based primary care for homebound seniors is complex, and practice constraints are unique. No quality-of-care standards exist.
Objective:
To identify process quality indicators that are essential to high-quality, home-based primary care.
Design:
An expert development panel reviewed established and new quality indicators for applicability to home-based primary care. A separate national evaluation panel used a modified Delphi process to rate the validity and importance of the potential quality indicators.
Participants:
Two national panels whose members varied in practice type, location, and setting.
Results:
The panels considered 260 quality indicators and endorsed 200 quality indicators that cover 23 geriatric conditions. Twenty-one (10.5%) quality indicators were newly created, 52 (26%) were modified, and 127 (63.5%) were unchanged. The quality indicators have decreased emphasis on interventions and have placed greater emphasis on quality of life.
Limitations:
The quality indicator set may not apply to all homebound seniors and might be difficult to implement for a typical home-based primary care program.
Conclusions:
The quality indicator set provides a comprehensive home-based primary care quality framework and will allow for future comparative research. Provision of these evidence-based measures could improve patient quality of life and longevity.
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