Abstract
BackgroundHome-based primary care (HBPC) is a multidisciplinary, ongoing care strategy that can provide cost-effective, in-home treatment to meet the needs of the approximately four million homebound, medically complex seniors in the U.S. Because there is no single model of HBPC that can be adopted across all types of health organizations and U.S. geographic regions, we conducted a six-site HBPC practice assessment to better understand different operation structures, common challenges, and approaches to delivering HBPC.MethodsSix practices varying in size, care team composition and location agreed to participate. At each site we conducted unstructured interviews with key informants and directly observed practices and procedures in the field and back office.ResultsThe aggregated case studies revealed important issues focused on team composition, patient characteristics, use of technology and urgent care delivery. Common challenges across the practices included provider retention and unmet community demand for home-based care services. Most practices, regardless of size, faced challenges around using electronic medical records (EMRs) and scheduling systems not designed for use in a mobile practice. Although many practices offered urgent care, practices varied in the methods used to provide care including the use of community paramedics and telehealth technology.ConclusionsLearnings compiled from these observations can inform other HBPC practices as to potential best practices that can be implemented in an effort to improve efficiency and scalability of HBPC so that seniors with multiple chronic conditions can receive comprehensive primary care services in their homes.
Highlights
Home-based primary care (HBPC) is a multidisciplinary, ongoing care strategy that can provide costeffective, in-home treatment to meet the needs of the approximately four million homebound, medically complex seniors in the U.S Because there is no single model of HBPC that can be adopted across all types of health organizations and U.S geographic regions, we conducted a six-site HBPC practice assessment to better understand different operation structures, common challenges, and approaches to delivering HBPC
Members of the practice discussed the operational structure of each practice in relation to four key areas: 1) Team composition: What is the team structure, and what are the roles and responsibilities of the team members? 2) Patient characteristics: How are new patients identified, selected, and enrolled into the program? 3) Use of technology: How is technology being used in home-based care? 4) Challenges: What are the challenges of HBPC practices? Field notes were taken during site visits to capture observations and insights
Description of HBPC practices Practices varied in terms of location, organizational structure, care team composition, specialized medical services provided, and practice size (Table 1)
Summary
Home-based primary care (HBPC) is a multidisciplinary, ongoing care strategy that can provide costeffective, in-home treatment to meet the needs of the approximately four million homebound, medically complex seniors in the U.S Because there is no single model of HBPC that can be adopted across all types of health organizations and U.S geographic regions, we conducted a six-site HBPC practice assessment to better understand different operation structures, common challenges, and approaches to delivering HBPC. The United States’ population of adults ages 65 and over is projected to double between 2005 and 2030, escalating the demand for medical care and increasing the national healthcare burden [1]. Those over age 80 are the most likely to be frail with multiple functional impairments and chronic conditions, and this population segment accounts for the highest health care consumption. There are an estimated four million homebound seniors in the U.S who need chronic care management and ongoing supportive services and account for a significant proportion of Medicare expenditures [4,5,6].
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