Brief Communication: National Quality-of-Care Standards in Home-Based Primary Care
- Kristofer L. Smith, MD, MPP;
- Theresa A. Soriano, MD, MPH; and
- Jeremy Boal, MD
Abstract
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.
Article and Author Information
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Disclaimer: The content and conclusions expressed herein are those of the authors and should not be construed as representing the official position or policy of the Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services or the U.S. government.
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Acknowledgments: The authors thank Ethan Halm, MD, MPH, and Katherine Ornstein, MPH, of the Mount Sinai School of Medicine for their thoughtful review of early drafts of the manuscript.
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Grant Support: By the Division of State, Community, and Public Health, Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services (grant no. 5 K01 HP 00053-02) and a Geriatric Academic Career Award (Dr. Boal).
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Potential Financial Conflicts of Interest: Consultancies: J. Boal (Visiting Nurse Service of New York).
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Requests for Single Reprints: Theresa Soriano, MD, MPH, The Mount Sinai Visiting Doctors Program, Mount Sinai School of Medicine, Box 1216, One Gustave L. Levy Place, New York, NY 10029; e-mail, theresa.soriano{at}mssm.edu.
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Current Author Addresses: Dr. Smith: Department of Medicine, Mount Sinai Medical Center, Box 1118, One Gustave L. Levy Place, New York, NY 10029.
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Drs. Soriano and Boal: The Mount Sinai Visiting Doctors Program, Mount Sinai School of Medicine, Box 1216, One Gustave L. Levy Place, New York, NY 10029.
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Author Contributions: Conception and design: K.L. Smith, T.A. Soriano, J. Boal.
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Analysis and interpretation of the data: K.L. Smith, T.A. Soriano.
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Drafting of the article: K.L. Smith, T.A. Soriano, J. Boal.
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Critical revision of the article for important intellectual content: K.L. Smith, T.A. Soriano, J. Boal.
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Final approval of the article: K.L. Smith, T.A. Soriano, J. Boal.
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Statistical expertise: K.L. Smith.
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Obtaining of funding: J. Boal.
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Administrative, technical, or logistic support: K.L. Smith.
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Collection and assembly of data: K.L. Smith.
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