Reliable and Valid Survey-Based Measures to Assess Quality of Care in Home-Based Serious Illness Programs

Abstract Background Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model. Methods Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n = 159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access. Results Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35, 22, 21%, respectively). Conclusion This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.

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Evaluating the Care Provision of a Community-Based Serious-Illness Care Program Via Chart Measures

10.21203/rs.2.16802/v2 ◽

2020 ◽

Author(s):

Christine Kistler ◽

Matthew Van Dongen ◽

Natalie Ernecoff ◽

Timothy Daaleman ◽

Laura Hanson

Keyword(s):

Quality Of Care ◽

Chart Review ◽

Retrospective Chart Review ◽

Care Program ◽

Academic Community ◽

Care Provision ◽

Community Based ◽

Serious Illness ◽

Home Based

Abstract Background: Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model.Methods: Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n=159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access.Results: Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35%, 22%, 21%, respectively). Conclusion: This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.

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Evaluating the Care Provision of a Community-Based Serious-Illness Care Program Via Chart Measures

10.21203/rs.2.16802/v1 ◽

2019 ◽

Author(s):

Christine Kistler ◽

Matthew Van Dongen ◽

Natalie Ernecoff ◽

Timothy Daaleman ◽

Laura Hanson

Keyword(s):

Quality Of Care ◽

Activities Of Daily Living ◽

Daily Living ◽

Chart Review ◽

Care Program ◽

Care Provision ◽

Community Based ◽

Serious Illness ◽

Home Based

Abstract Keywords: home-based primary care, home-based palliative care, community-based care, quality-of-care, serious-illness care Background: Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model. Methods: Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n=159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access. Results: Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35%, 22%, 21%, respectively). Conclusions: This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures. List of Abbreviations: REACH program (Reaching out to Enhance the care of Adults in their Communities and their Homes), electronic health record (EHR), the Charlson Comorbidity Index (CCI), instrumental activities of daily living (IADLs), activities of daily living (ADLs), Veterans Affairs St. Louis University Mental Status Exam (VA-SLUMS)

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Evaluating the Care Provision of a Community-Based Serious-Illness Care Program Via Chart Measures

10.21203/rs.2.16802/v3 ◽

2020 ◽

Author(s):

Christine Kistler ◽

Matthew Van Dongen ◽

Natalie Ernecoff ◽

Timothy Daaleman ◽

Laura Hanson

Keyword(s):

Quality Of Care ◽

Chart Review ◽

Retrospective Chart Review ◽

Care Program ◽

Academic Community ◽

Care Provision ◽

Community Based ◽

Serious Illness ◽

Home Based

Abstract Background: Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model.Methods: Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n=159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access.Results: Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35%, 22%, 21%, respectively).Conclusion: This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.

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How can we Assess Quality of Care in Surgery?

Key Topics in Surgical Research and Methodology ◽

10.1007/978-3-540-71915-1_13 ◽

2010 ◽

pp. 151-164

Author(s):

Erik Mayer ◽

Andre Chow ◽

Lord Ara Darzi ◽

Thanos Athanasiou

Keyword(s):

Quality Of Care ◽

Assess Quality

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Impact of home-based, patient-centered support for people with advanced illness in an open health system: A retrospective claims analysis of health expenditures, utilization, and quality of care at end of life

Palliative Medicine ◽

10.1177/0269216317711824 ◽

2017 ◽

Vol 32 (2) ◽

pp. 485-492 ◽

Cited By ~ 3

Author(s):

Sylvia EK Sudat ◽

Anjali Franco ◽

Alice R Pressman ◽

Kenneth Rosenfeld ◽

Elizabeth Gornet ◽

...

Keyword(s):

Quality Of Care ◽

Health System ◽

End Of Life ◽

Health Expenditures ◽

Claims Analysis ◽

Advanced Illness ◽

Patient Centered ◽

System A ◽

Home Based

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Pre hospital indicators in assessing the quality of care for patients with acute coronary syndrome

Revista Gaúcha de Enfermagem ◽

10.1590/1983-1447.2015.03.50869 ◽

2015 ◽

Vol 36 (3) ◽

pp. 49-55

Author(s):

Gláucia de Souza Omori Maier ◽

Eleine Aparecida Penha Martins ◽

Mara Solange Gomes Dellaroza

Keyword(s):

Acute Coronary Syndrome ◽

Quality Of Care ◽

Medical Record ◽

Heart Attack ◽

Tertiary Hospital ◽

Coronary Syndrome ◽

History Of ◽

Assess Quality ◽

Record Review

Objective: to assess quality indicators related to the pre-hospital time for patients with acute coronary syndrome.Method: collection took place at a tertiary hospital in Paraná between 2012 and 2013, through interviews and a medical record review. 94 patients participated, 52.1% male, 78.7% who were over 50 years old, 46.9% studied until the fourth grade, 60.6% were diagnosed with acute myocardial infarction.Results: the outcomes were the time between the onset of symptoms and the decision to seek help with an average of 1022min ± 343.13, door-to-door 805min ± 181.78; and reperfusion, 455min ± 364.8. The choice to seek out care within 60 min occurred in patients who were having a heart attack, and longer than 60 min in those with a history of heart attack or prior catheterization.Conclusion: We concluded that the pre-hospital indicators studied interfered with the quality of care.

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