Abstract
Letters Health AffairsVol. 34, No. 4: Cost & Quality Of Cancer Care Home-Based Medical Care And The Triple AimStephen C. Acosta AffiliationsPortland, OregonPUBLISHED:April 2015Free Accesshttps://doi.org/10.1377/hlthaff.2015.0205AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSClinical careTriple AimOrganization of care I disagree with the assertion by Bruce Leff and coauthors (Jan 2015) that the absence of peer-reviewed and published quality-of-care standards for home-based medical care is the reason for difficulty in delivering that care. In their article the authors gave many examples of care provision that hewed to the Triple Aim for health care. 1 The difficulty, as Leff has pointed out before, 2 lies in delivering this care in a fee-based system that does not view the Triple Aim as an intrinsic goal for US health care. Measuring twenty indicators will generate data that some insurers may find valuable. However, my experience as the primary physician provider for the Portland Veterans Affairs Medical Center’s house-call division, Program at Home, 3 as well as my interaction with its home-based primary care service, showed me that similar data collection and recording can take up to 50 percent of a professional’s daily time. That measure, rarely included in the evaluation of the effectiveness of home care, is a bottleneck to increasing the number of patients who receive services. The expansion of home-based medical care is still awaiting the arrival of a critical mass, so to speak, of health care payers who believe in the concept that an ounce of prevention is worth more than a pound of cure.NOTES1 Berwick DM , Nolan TW , Whittington J . The Triple Aim: care, health, and cost . Health Aff (Millwood) . 2008 ; 27 ( 3 ): 759 – 69 . Go to the article, Google Scholar 2 Leff B , Burton J . The future history of home care and physician house calls in the United States . J Gerontol A Biol Sci Med Sci . 2001 ; 56 ( 10 ): M603 – 8 . Crossref, Medline, Google Scholar 3 Mader SL , Medcraft MC , Joseph C , Jenkins KL , Benton N , Chapman K , et al. Program at Home: a Veterans Affairs healthcare program to deliver hospital care in the home . J Am Geriatr Soc . 2008 ; 56 ( 12 ): 2317 – 22 . Crossref, Medline, Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 1 History Published online 1 April 2015 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF downloadCited byThe effects of home-based primary care on Medicare costs at Spectrum Health/Priority Health (Grand Rapids, MI, USA) from 2012-present: a matched cohort study7 March 2018 | BMC Health Services Research, Vol. 18, No. 1
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