Bruce Leff1,2,3, Christine M Weston2, Sarah Garrigues4,5,6, Kanan Patel4,5,6, Christine Ritchie4,5,6. 1. Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland. 2. Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. 3. Department of Community and Public Health, School of Nursing, Johns Hopkins University, Baltimore, Maryland. 4. Division of Geriatrics, University of California at San Francisco, San Francisco, California. 5. San Francisco Veterans Affairs Medical Center, San Francisco, California. 6. Jewish Home San Francisco, San Francisco, California.
Abstract
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.
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.
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