New tool to assess the quality of home health care

Jan 12 2005

University of Michigan researchers are part of a team that has developed a new tool to assess the quality of home health care, with the goal of improving care and providing meaningful feedback about the care.

In the current issue of The Gerontologist, the 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.

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 U-M's 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.

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.