Home-Based Primary Care Practices in the United States: Current State and Quality Improvement Approaches
- Autores: Bruce Leff, Christine M. Weston, Sarah Garrigues, Kanan Patel, Christine S. Ritchie
- Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 63, Nº. 5, 2015, págs. 963-969
- Idioma: inglés
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Resumen
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.
