Building a movement to advance care quality at home
We are a national organization dedicated to ensuring that homebound persons receive high-quality, evidence-based medical care in their homes by creating a quality framework and measures for the field and through a coordinated program of quality improvement and applied research. Browse our site to learn more.
Almost 2 million older adults are completely or mostly homebound, and another 5.5 million are semi-homebound and are dependent on others or have difficulty leaving their homes. The homebound are people who suffer with multiple chronic conditions, impairments in their functional abilities, and often challenging social situations. They experience substantial mortality — approximately 20% – 40% over two years, depending on the degree to which they are homebound.
Because they cannot easily access primary care, they commonly call 911 for an ambulance to take them to an emergency room when medical issues arise. They commonly experience fragmented, discontinuous follow-up care. Despite being high-need, high-cost patients, they are often invisible in plain sight to hospitals, health care systems, and payers.
Home-based medical care, which encompasses both home-based primary care and home-based palliative care, provides a mechanism for such patients to obtain ongoing care in their homes.
In home-based primary care, patients receive comprehensive longitudinal primary medical care at home from an interprofessional team of physicians, nurse practitioners, or both, together with nurses, social workers, and skilled therapists. Home-based palliative care provides care in the home for people with serious illnesses and focuses on offering relief from the symptoms, pain, and stress of a serious illness. Its goal is to improve quality of life for patients and their families. Similar to home-based primary care, it is provided by a team of providers. Home-based medical care have emerged as evidence-based clinically effective and cost-saving models to care for the homebound.
As our health care systems shift to value-based care, home-based medical care is at a particular disadvantage due to: lack of quality indicators appropriate to the needs of patients care for at home, lack of a mechanism for home-based medical care practices to report quality of care data and engage in performance reporting with CMS, and lack of a focus on quality improvement approaches in the field.
Drs. Christine Ritchie and Bruce Leff recognized the need to focus on quality of care in home-based medical care and got to work. With the support of the Retirement Research Foundation, the Commonwealth Fund, and the California Health Care Foundation, they established a Stakeholder Network of experts from exemplar home-based medical care practices, professional societies, and advocacy groups. They led qualitative research to create a quality of care framework for home-based medical care and then an initial set of quality measures specifically for home-based medical care.
Then, in partnership with the West Health Institute, they and their team developed a Centers for Medicare and Medicaid Services (CMS)-approved Qualified Clinical Data Registry (QCDR). A QCDR provides a mechanism for home-based medical care practices to aggregate and benchmark quality data, engage in quality improvement, and report data to CMS for performance reporting. In 2018, with support of The John A. Hartford Foundation, they conducted a Pilot Learning Collaborative with 5 home-based medical care practices, as a prelude to the current National Home-based Primary Care and Palliative Care Learning Collaborative.
Data to inform practice and health care policy are critical to advancing the field of home-based medical care. In collaboration with the West Health Institute and the Home-Centered Care Institute, we are developing a data warehouse for applied research in the field. This data warehouse will include data on: quality of care provided in home-based medical care, characteristics of home-based medical care practices and their patients, and medical claims data.