Abstract
IntroductionThe persistent fragmentation of home healthcare reflects inadequate coordination between care providers. Still, while factors at the system (e.g., regulations) and organisational (e.g., work environment) levels crucially influence homecare organisation, coordination and ultimately quality, knowledge of these factors and their relationships in homecare settings remains limited.ObjectivesThis study has three aims: [1] to explore how system-level regulations lead to disparities between homecare agencies’ structures, processes and work environments; [2] to explore how system- and organisation-level factors affect agency-level homecare coordination; and [3] to explore how agency-level care coordination is related to patient-level quality of care.Design and methodsThis study focuses on a national multi-center cross-sectional survey in Swiss homecare settings. It will target 100 homecare agencies, their employees and clients for recruitment, with data collection period planned from January to June 2021. We will assess regulations and financing mechanisms (via public records), agency characteristics (via agency questionnaire data) and homecare employees’ working environments and coordination activities, as well as staff- and patient-level perceptions of coordination and quality of care (via questionnaires for homecare employees, clients and informal caregivers). All collected data will be subjected to descriptive and multi-level analyses.DiscussionThe first results are expected by December 2021. Knowledge of factors linked to quality of care is essential to plan and implement quality improvement strategies. This study will help to identify modifiable factors at multiple health system levels that might serve as access points to improve coordination and quality of care.
Highlights
The persistent fragmentation of home healthcare reflects inadequate coordination between care providers
Knowledge of factors linked to quality of care is essential to plan and implement quality improvement strategies
This study will help to identify modifiable factors at multiple health system levels that might serve as access points to improve coordination and quality of care
Summary
The persistent fragmentation of home healthcare reflects inadequate coordination between care providers. In 2018, for the first time in history, persons aged 65 years or older outnumbered children under five globally. Demographic aging will continue for some time: by 2050, in Northern North America and Europe, one person in four is expected to be 65 years or older [1]. Current estimates indicate that the global population of older old persons (≥ 80 years) will have climbed from its 2019 level of 143 million to 426 million— nearly 300% the current fig [1]. Even when care-dependent, though, most prefer to live in their own homes as long as possible [4, 5]; and homecare is normally a costeffective alternative to inpatient or residential care [6]. Care is shifting progressively from institutional to homecare settings [4, 7]
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