title: The invisible homebound: setting quality-of-care standards for home-based primary and palliative care.
abstract: Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care. Home-based medical care can improve outcomes and reduce health care costs, but this care operates in a quality measurement desert, having been largely left out of the national conversation on care quality. To address this shortcoming, two of the authors created the National Home-Based Primary and Palliative Care Network, an organization whose members include exemplary home-based medical practices, professional societies, and patient advocacy groups. This article describes the current status of home-based medical care in the United States and offers a brief narrative of a fictional homebound patient and the health events and fragmented care she faces. The article then describes the network's quality-of-care framework, which includes ten quality-of-care domains, thirty-two standards, and twenty quality indicators that are being tested in the field. The same two authors also developed a practice-based registry that will be used for quality-of-care benchmarking, practice-based quality improvement, performance reporting, and comparative effectiveness research. Together, these steps should help bring home-based medical care further into the mainstream of US health care.
authors.affiliation: Bruce Leff (bleff@jhmi.edu) is a professor of medicine at the Johns Hopkins University School of Medicine, in Baltimore, Maryland.
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.affiliation: Charlotte M. Carlson is an associate medical director at On Lok Senior Health Services, in San Francisco, California.
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Carlson
authors.affiliation: Debra Saliba is director of the University of California, Los Angeles, Borun Center and a research physician in the Veterans Affairs Greater Los Angeles Healthcare System.
authors.forename: Debra
authors.initials: D
authors.lastname: Saliba
authors.affiliation: Christine Ritchie is a professor in the Department of Medicine at the University of California, San Francisco.
authors.forename: Christine
authors.initials: C
authors.lastname: Ritchie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000592:standards; D002908:Chronic Disease / Q000628:therapy*; D003299:Cooperative Behavior; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006301:Health Services Needs and Demand / Q000592:standards; D006699:Home Care Services / Q000592:standards*; D018577:Homebound Persons / Q000706:statistics & numerical data*; D006792:House Calls; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010166:Palliative Care / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D014481:United States
keywords: Health Reform; Home; Organization and Delivery of Care; Quality Of Care; Special Populations