Abstract
More than 6 million adults in the United States are homebound or semi-homebound and
would benefit from home-based medical care (HBMC). There is currently no nationally
recognized quality of care framework for home-based medical care. We sought to capture
diverse stakeholder perspectives on the essential aspects of quality HBMC and create
a quality of care framework for homebound adults. A qualitative analysis of semistructured
interviews from purposive sampling of key HBMC stakeholders was performed. Leaders
from 12 exemplar HBMC practices (clinicians and administrators), advocacy groups (American
Association of Retired Persons, National Partnership for Women and Families, Kaiser
Family Foundation), and representatives from 3 key professional medical societies
associated with HBMC participated in phone interviews. Semistructured interviews were
based on domains of quality developed by the National Quality Forum (NQF) for individuals
with multiple chronic conditions. We identified 3 categories of quality HBMC: provider
and practice activities; provider characteristics; and outcomes for patients, caregivers,
and providers. Within these 3 categories, we identified 10 domains and 49 standards
for quality HBMC. These included 3 new domains (comprehensive assessment, patient/caregiver
education, and provider competency) as well as specification and adaptation of the
NQF Framework for Multiple Chronic Conditions domains for HBMC. Notably, several quality
domains emanating from the NQF Framework for Multiple Chronic Conditions (transitions,
access, and patient/caregiver engagement) were applicable to HBMC. This quality of
care framework serves as a guide for HBMC practices seeking to improve their care
quality and as a starting point for health systems and payers to ensure value from
HBMC practices with whom they work.
Keywords
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Article info
Publication history
Published online: July 25, 2018
Footnotes
The authors declare no conflicts of interest.
This work was supported by the Commonwealth Fund and the Retirement Research Foundation, national private foundations based in New York City and Chicago that support independent research on health care and make grants to improve health care practice and policy. The views presented here are those of the authors and not necessarily those of the Commonwealth Fund or the Retirement Research Foundation, their directors, officers, or staff.
This work was supported by the Commonwealth Fund, New York, NY (Grant 20150692) and the Retirement Research Foundation, Chicago, IL (Grant 2013-239).
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