Stakeholder Perspectives on Development of a Home-Based Primary Care Practice Recognition Program

Home-based primary care (HBPC), which provides longitudinal interdisciplinary primary care to functionally impaired patients at home, rather than in traditional ambulatory clinics, improves patient outcomes, but remains relatively invisible to key stakeholders and has not scaled. Practice recognition programs are formal processes that evaluate and formally acknowledge a health care practice for achieving specific standards and have been developed for various fields. The aim of this study was to assess key stakeholder views on the potential benefits and challenges, unintended consequences of implementation, and potential core components of an HBPC practice recognition program.

Cross-sectional.

Key HBPC stakeholders nationally: clinicians and practice leaders, payers, health system leaders, and quality of care stakeholders.

Sequential mixed-methods study.

Focus groups of HBPC stakeholders identified key themes that informed development of national online survey on HBPC practice recognition. The online survey was sent to 2603 HBPC stakeholders with 298 surveys completed (11.8% response rate). A substantial plurality of respondents thought a practice recognition program could deliver value to the field of HBPC across multiple domains; 74% of respondents thought their practice would engage in a practice recognition process if developed. Concerns and potential unintended consequences focused on potential financial, practice resource, and administrative burden, possible failure of practice recognition to help HBPC improve care delivery or attain external stakeholders' recognition, and challenges potentially faced by small practices. In multivariable logistic regression, an increased likelihood of engaging in a practice recognition program was associated with respondent being an HBPC employee vs HBPC practice owner, odds ratio 2.76 (95% CI 1.19, 6.40).

Key stakeholders in HBPC view the development of an HBPC practice recognition program positively, but with caveats. Development of an HBPC practice recognition process should incorporate ongoing stakeholder input.