Home-Based Primary Care Practices in the United States: Current State and Quality Improvement Approaches

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Background

Frail, elderly patients with multiple chronic conditions are often too sick or disabled to visit a doctor when they need care, making it difficult for providers to detect and respond to changes in health status. Home-based primary care programs that allow physicians, nurses, and other providers to make house calls offer an alternative. Commonwealth Fund–supported researchers conducted a national survey of home-based primary care practices to understand how they vary and assess their engagement and interest in quality improvement initiatives.

Key Findings

  • The majority of the 272 practices were small, with a mean daily census of 457 patients. But some were large practices, with as many 30,000 patients and engagement with a wide array of providers, including physical therapists, clinical pharmacists, and social workers. The larger practices were newer and may represent a growing phenomenon.
  • Eighty-eight percent of the practices offered around-the-clock coverage for urgent concerns, with physicians or nurse practitioners most commonly providing the care.
  • Nearly 90 percent used electronic medical record systems.
  • While only one-third of the practices use a defined quality improvement process, a substantial portion engaged in related activities, including meeting to discuss the care of specific patients (60%), surveying patients (51%), and participating in medical home programs (33%).
  • Ninety percent of practices indicated they would or might participate in a quality improvement program that would provide timely feedback on home-based primary care and palliative care-specific quality indicators. 

Conclusions

While the survey found variation in the size of practices, business models, and approaches to care, the results suggest there is widespread interest in quality benchmarking and improvement among home-based primary care practices. 

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Publication Details

Publication Date:
May 18, 2015
Authors:
Bruce Leff, Christine Ritchie, Christine M. Weston, Sarah Garrigues, and Kanan Patel
Contact:
Mary Mahon, Vice President, Public Information, The Commonwealth Fund
E-mail: mm@cmwf.org
Summary Writer:
Sarah Klein
Citation:
B. Leff, C. M. Weston, S. Garrigues et al., “Home-Based Primary Care Practices in the United States: Current State and Quality Improvement Approaches, Journal of the American Geriatrics Society, published online May 4, 2015.
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