Brief communication: National quality-of-care standards in home-based primary care

Background: Home-based primary care for homebound seniors is complex, and practice constraints are unique. No quality-of-care standards exist. Objective: To identify process quality indicators that are essential to high-quality, home-based primary care. Design: An expert development panel reviewed established and new quality indicators for applicability to home-based primary care. A separate national evaluation panel used a modified Delphi process to rate the validity and importance of the potential quality indicators. Participants: Two national panels whose members varied in practice type, location, and setting. Results: The panels considered 260 quality indicators and endorsed 200 quality indicators that cover 23 geriatric conditions. Twenty-one (10.5%) quality indicators were newly created, 52 (26%) were modified, and 127 (63.5%) were unchanged. The quality indicators have decreased emphasis on interventions and have placed greater emphasis on quality of life. Limitations: The quality indicator set may not apply to all home-bound seniors and might be difficult to implement for a typical home-based primary care program. Conclusions: The quality indicator set provides a comprehensive home-based primary care quality framework and will allow for future comparative research. Provision of these evidence-based measures could improve patient quality of life and longevity.