Abstract
BackgroundAlthough quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model.MethodsRetrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n = 159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access.ResultsPatients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35, 22, 21%, respectively).ConclusionThis study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.
Highlights
Quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice
The program has been evaluated for its impact in older adults with dementia, its impact on healthcare utilization, and in palliative care, but not in proposed quality-of-care [16, 17]
Two research assistants independently completed a subset of chart reviews of visit notes and patient data in the electronic health record (EHR), reconciled differences until reviews were consistent, and conferred regularly to prevent drift and maintain data quality
Summary
Quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a communitybased serious-illness care program, a combined home-based primary and palliative care model. Operational gaps currently impede the ready adoption of quality-of-care measurement in community-based serious-illness care programs. If community-based serious-illness care programs are to demonstrate value and ensure accountability in the care of vulnerable patients, further assessment needs to be done [12, 13]. To better understand the current quality-of-care, we created operational definitions for selected quality-of-care measures and used them to evaluate a community-based seriousillness care program. The aim of the study was to determine if we could operationalize proposed quality-of-care domains and evaluate our program [8, 9]
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