JAMDA
Volume 10, Issue 5 , Pages 304-313 , June 2009

A Clinical Microsystem Model to Evaluate the Quality of Primary Care for Homebound Older Adults

  • Tobie H. Olsan, PhD, MPA, RN

      Affiliations

    • University of Rochester, School of Nursing, Rochester, NY
    • Corresponding Author InformationAddress correspondence to Tobie H. Olsan, PhD, MPA, RN, University of Rochester, School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642.
  • ,
  • Bernard Shore, MD

      Affiliations

    • Jewish Home of Rochester and University of Rochester, Rochester, NY
  • ,
  • Patricia D. Coleman, PhD, RN

      Affiliations

    • University of Rochester, Rochester, NY and Crouse Hospital, Syracuse, NY

References 

  1. Brickner PW, Duque T, Kaufman A, et al. The homebound aged: A medically unreached group. Ann Intern Med. 1975;82:1–6
  2. DiPollina L, Gold G, Meier DE. Health care for the homebound older adult: A medical model. Mt Sinai J Med. 1993;60:488–491
  3. Muramatsu N, Mensah E, Cornwell T. A physician house call program for the homebound. Jt Comm J Quality Saf. 2004;30:266–276
  4. Smith KL, Ornstein K, Soriano T, et al. A multidisciplinary program for delivering primary care to the underserved urban homebound: Looking back and moving forward. J Am Geriatr Soc. 2006;54:1283–1289
  5. Bishop CE. Where are the missing elders? The decline in nursing home use, 1985 and 1995. Health Aff. 1999;18:146–155
  6. Kassner E, Reinhard S, Fox-Grage W, et al. A balancing act: State long-term care reform: Available at: http://www.aarp.org/research/longtermcare/programfunding/2008_10_ltc.html. Accessed October 29, 2008.
  7. Kaiser Family Foundation. Capitol Hill watch: Legislation would create Medicare pilot program to expand at-home services for some beneficiaries with chronic conditions. Available at: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=54762. Accessed October 1, 2008.
  8. Yaggy SD, Michener JL, Yaggy D, et al. Just for Us: An academic medical center-community partnership to maintain the health of a frail low-income senior population. Gerontologist. 2006;46:271–276
  9. Donaldson MS, Mohr JJ. Exploring innovation and quality improvement in health care micro-systems: A cross-case analysis. Available at: http://www.nap.edu/catalog/10096.html#toc. Accessed November 12, 2006.
  10. Nelson EC, Batalden PB, Huber TP, et al. Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. Jt Comm J Qual Improv. 2002;28:472–493
  11. Institute of Medicine . To err is human: Building a safer health system. Washington, DC: National Academies Press; 2000;
  12. Institute of Medicine . Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press; 2001;
  13. Barach P, Johnson JK. Understanding the complexity of redesigning care around the clinical microsystem. Qual Saf Health Care. 2006;15:i10–i16
  14. Zimmerman B, Lindberg C, Plsek P. Edgeware: Insights from complexity science for health care leaders. Irving, TX: VHA; 2001;
  15. Quinn JB. Intelligent enterprise: A knowledge and service based paradigm for industry. New York: The Free Press; 1992;
  16. Plsek P. Building a mind-set of service excellence. Fam Pract Manag. 2002;9:41–46
  17. Nelson EC, Godfrey MM, Batalden PB, et al. Clinical microsystems, Part 1. The building blocks of health systems. Jt Comm J Qual Patient Saf. 2008;34:367–378
  18. Nelson EC, Batalden PB, Homa K, et al. Microsystems in health care: Part 2. Creating a rich information environment. Jt Comm J Qual Saf. 2003;29:5–15
  19. Wasson JH, Anders SG, Moore GL, et al. Clinical microsystems, Part 2. Learning from micro practices about providing patients the care they want and need. Jt Comm J Qual Patient Saf. 2008;34:445–452
  20. Godfrey MM, Melin CN, Muething SE, et al. Clinical microsystems, Part 3. Transformation of two hospitals using microsystem, mesosystem, and macrosystem strategies. Jt Comm J Qual Patient Saf. 2008;34:591–603
  21. Anderson RA, Issel LM, McDaniel RR. Nursing homes as complex adaptive systems: Relationship between management practice and resident outcomes. Nurs Res. 2003;52:12–21
  22. Finucane TE, Fox-Whalen S, Burton JR. The elder housecall program at Johns Hopkins. J Long Term Home Health Care. 1994;13:29–36
  23. Keenan JM, Boling PA, Schwartzberg JG, et al. A national survey of the home visiting practice and attitudes of family physicians and internists. Arch Intern Med. 1992;152:2025–2032
  24. Laditka SB, Jenkins CL, Trevisani G, Mathews K. The doctor on the patient's turf: Assessing patient satisfaction with physician home visit programs. Home Health Care Serv Q. 2001;19:1–16
  25. Meyer G, Gibbons RV. House calls to the elderly—A vanishing practice among physicians. N Engl J Med. 1997;337:1815–1820
  26. Perkel RL, Kairys MZ, Diamond JJ, et al. Eleven years of house calls: A description of a family practice model residency program's experience from 1981–1992 with an urban home visit program for the elderly. J Long Term Home Health Care. 1994;13:13–26
  27. Reuben DB, Fried TR, Wachtel TJ, Tinetti ME. When the patient cannot come to the doctor: A medical house calls program. J Am Geriatr Soc. 1998;46:226–231
  28. Scanameo AM, Fillit H. House calls: A practical guide to seeing the patient at home. Geriatrics. 1995;50:33–3639
  29. Dick K, Frazier SC. An exploration of nurse practitioner care to homebound frail elders. J Am Acad Nurse Pract. 2006;18:325–334
  30. Restrepo A, Davitt C, Thompson S. House calls: Is there an APN in the house?. J Am Acad Nurse Pract. 2001;13:560–564
  31. Antezberger GJ, Stricklin ML, Gauntner D, et al. VNA HouseCalls of Greater Cleveland Ohio: Development and pilot evaluation of a program for high-risk older adults offering primary medical care in the home. Home Health Care Serv Q. 2006;25:155–166
  32. Hughes SL, Cummings J, Weaver F, et al. A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill. Health Serv Res. 1992;26:801–817
  33. Hughes SL, Weaver FM, Giobbie-Hurder A, et al. Effectiveness of team-managed home-based primary care: A randomized multicenter trial. JAMA. 2000;284:2877–2885
  34. Ritchie CA, Thomas DR. Home-based primary care in the VA setting, with a focus on Birmingham, Alabama. J Long Term Home Health Care. 1998;17:18–25
  35. Kellogg FR, Bricker PW. Long-term home health care for the impoverished frail homebound aged: A twenty-seven year experience. J Am Geriatr Soc. 2000;48:1002–1011
  36. Alessi CA, Stuck AE, Aronow HU, et al. The process of care in preventive in-home comprehensive geriatric assessment. J Am Geriatr Soc. 1997;45:1044–1050
  37. Stuck AE, Aronow HU, Steiner A, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med. 1995;333:1184–1189
  38. Naylor MD, Brooten D, Campbell T, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA. 1999;281:613–620
  39. Wheatley M. Leadership and the new science: Learning about organizations from an orderly universe. San Francisco: Berrett-Koehler; 1992;
  40. Mohr JJ, Batalden PB. Improving safety on the front lines: The role of clinical microsystems. Qual Saf Health Care. 2002;11:45–50
  41. Cooper DF, Granadillo OR, Stacey CM. Home-based primary care: The care of the veteran at home. Home Healthc Nurse. 2007;25:315–322
  42. Godfrey MM, Nelson EC, Wasson JH, et al. Microsystems in health care: Part 3. Planning patient-centered services. Jt Comm J Qual Saf. 2003;29:159–170
  43. Batalden PB, Nelson EC, Mohr JJ, et al. Microsystems in health care: Part 5. How leaders are leading. Jt Comm J Qual Saf. 2003;29:297–308
  44. Brodeur D. Health care institutional ethics: Broader than clinical ethics. In:  Monagle JF,  Thomasma DC editor. Health care ethics: Critical issues for the 21st century. Gaithersburg, MD: Aspen; 1997;497–504
  45. Smith KL, Soriano TA, Boal J. Brief communication: National quality of care standards in home-based primary care. Ann Intern Med. 2007;146:188–192
  46. Wenger NS, Solomon D, Roth CP, et al. The quality of medical care provided to vulnerable community-dwelling older patients. Ann Intern Med. 2003;139:740–747
  47. Hayashi JL, Phillips KA, Arbaje A, et al. A curriculum to teach internal medicine residents to perform house calls for older adults. J Am Geriatr Soc. 2007;55:1287–1294

 T.H.O. is a T32 postdoctoral fellow in geriatrics sponsored by the National Institute on Aging #AG020493–01A2.

PII: S1525-8610(09)00081-4

doi: 10.1016/j.jamda.2009.02.003

JAMDA
Volume 10, Issue 5 , Pages 304-313 , June 2009