Home-based primary care practices in the United States: current state and quality improvement approaches.
OBJECTIVE
To describe the characteristics of home-based primary care practices: staffing, administrative, population served, care practices, and quality of care challenges.


METHODS
Survey of home-based primary care practices.


METHODS
Home-based primary care practices in the United States.


METHODS
Members of the American Academy of Home Care Medicine and nonmember providers identified by surveyed members.


METHODS
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.
Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.|Department of Community and Public Health, School of Nursing, Johns Hopkins University, Baltimore, Maryland.
Bruce
B
Leff
Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Christine M
CM
Weston
Division of Geriatrics, University of California at San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.|Jewish Home San Francisco, San Francisco, California.
Sarah
S
Garrigues
Division of Geriatrics, University of California at San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.|Jewish Home San Francisco, San Francisco, California.
Kanan
K
Patel
Division of Geriatrics, University of California at San Francisco, San Francisco, California.|San Francisco Veterans Affairs Medical Center, San Francisco, California.|Jewish Home San Francisco, San Francisco, California.
Christine
C
Ritchie
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019538:Health Care Surveys; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
home-based palliative care; home-based primary care; house calls; quality of care