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New Tool for Measuring Home Health Care Quality
Introduced
Jan. 14, 2005 Researchers say they have developed
a new tool to measure the quality of home health care, which is getting
increased emphasis, based on a goals of improving care and providing
meaningful feedback about the care.
In the current issue of The Gerontologist,
the development team reports on home care quality indicators based on 22
measures. Home care agencies, governments and consumers can use the
results of these 22 measures to evaluate the quality of home care.
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The assessment is a project of interRAI, a
26-country network of researchers and clinicians working on health
information systems to improve the care of the elderly and people with
disabilities.
Brant Fries, a professor of health management and
policy at the University of Michigans School of Public Health and a
faculty member at the U-M Institute of Gerontology, helped develop the
Resident Assessment Instrument (RAI), a federally mandated survey. More
than 15 million RAI assessments of elderly nursing home residents are
performed each year.
Subsequently, he founded interRAI, an international
research consortium which is taking the same idea around the world to
look at nursing homes and home health care. Fries is a co-author on the
Gerontologist paper.
John Hirdes of the University of Waterloo
Department of Health Studies and Gerontology was the paper's first
author. Collaborators included John Morris, Hebrew SeniorLife in Boston;
Naoki Ikegami, Keio University School of Medicine in Tokyo; David
Zimmerman, University of Wisconsin; Dawn Dalby, University of Waterloo;
Pablo Aliaga, University of Michigan; Suzanne Hammer, International
Medical Corps; and Richard Jones, Hebrew SeniorLife Rehabilitation
Center.
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Fries said one benefit of developing comprehensive
data on performance is that care organizations often do not know their
strengths and weaknesses. He said it's common to ask managers what
they're good at, but the data fails to back up the managers'
impressions.
"You need to know where you are so that it's
sustainable and so best practices can be shared," Fries said. "You also
need a clear view of where you need to improve."
The 22 areas measured all come from the Minimum
Data Set---Home Care, an interRAI assessment that has been adopted in 10
U.S. states and several other countries. A big advantage is that the
measures are available with no further data collection.
The newly developed set of indicators look at
processes, such as administering flu vaccine and reviewing patient
medication, and outcomes, like ratings of the functioning of clients in
activities of daily living (ADL).
Researchers looked at 73 possible indicators, but
screened out those that did not give good statistical information to
compare home care agencies.
Fries said studying the data shows that no one
place---no home care provider, no region---does everything well. Those
that excel on some measures of patient care are usually average or poor
in others, for example.
There were some areas the researchers found where
many home care agencies could improve. For example, 32 percent of home
care clients in the study population had not received an influenza
vaccination in the last two years, and more than 70 percent of home care
clients who could benefit from rehabilitation did not receive physical
or occupational therapy.
The number of people receiving home care in any
region is generally much larger than the number receiving facility-based
care, as home care now represents one of the most important sectors for
health spending. More than 20,000 providers deliver home care services
to some 7.6 million individuals who require services because of acute
illness, long-term health conditions, permanent disability or terminal
illness.
"Home care serves as an important link among
primary care, acute care, long-term care and mental health services.
Quality improvements in home care may benefit the entire health care
system," Fries said.
In virtually every sector of the health care
system, efforts are under way to improve the quality of care provided,
increase the cost effectiveness of service delivery, facilitate the
identification and adoption of best practices, and enhance the public
accountability of service providers.
These changes are occurring at a rapid pace, often
in the absence of clear evidence regarding key questions, such as who
should be the primary target population for specific services and what
services will be most cost effective.
As well, there are questions about how the outcomes
of home care should be evaluated, what role family members should play
in care provision, and how a home care system that involves multiple
service providers can be accountable.
For the current issue of the Gerontologist:
http://gerontologist.gerontologyjournals.org/current.shtml
InterRAI:
http://www.interrai.org/
More information about Fries:
http://ipumich.temppublish.com/public/experts/ExpDisplay.php?ExpID=271
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