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Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

Fri, Nov 3, 2017
Friday, Nov 3, 2017, Washington - D.C.
H3IT: Home Healthcare, Hospice, and Information Technology Conference Nashville, TN, 2015
Informing Health IT Adoption Strategies in Home
Care Through Identifying Key Performance
Improvement Domains for Home Health Agencies
Güneş Koru
, Dari Alhuwail
, Robert Rosati
mproving the quality of healthcare can result in better health outcomes and patient satisfaction while possibly
reducing the overall costs of healthcare.
Historically, a number of initiatives were designed and implemented to
improve the quality of home care in the United States.
In the future of home care, quality improvement eorts
will continue to take an important role, and health information technology (IT) will be expected to eectively
serve and support such eorts.
Recently, the Centers for Medicare and Medicaid Services (CMS) proposed a rule requiring
home health agencies (HHAs) to design and implement quality assessment and performance improvement (QAPI) programs
to fulll the conditions of participation in Medicare.
CMS set the end goal as observable improvements in the quality
measures without providing specic advice about how to improve outcomes through QAPI by acknowledging its diculty.
Instead, CMS advises HHAs to adopt customized QAPI programs by considering the specic needs and conditions of their
organization and patient population. To support customized QAPI programs, this study investigated quality attributes for
home care with an emphasis on Medicare HHAs. These quality attributes constitute key performance improvement domains
(KPIDs), which can be used to view, characterize, and improve the performance of an HHA. Consequently, KPIDs can serve
as useful tools in various discussions and brainstorming activities on how contextual improvement can b e achieved and how
health IT can be a vehicle for improvement.
Methods: A qualitative research approach was preferred to obtain contextual and rich data.
The Framework Method,
used in many research domains including, medicine,
was adopted. Qualitative data were collected via four focus group
discussions with twenty home care domain experts. Focus groups were preferred due to their dynamic nature because they
enable direct involvement of all participants, facilitate interactions and discussions, and potentially lead to consensus among
The analysis results were further rened in an online forum and validated at a nal meeting.
Results: From the focus group discussions, a well-dened set of 17 KPIDs emerged under four categories, namely, (i)
Economical Value: 1) worthiness, 2) aordability; (ii) Sociocultural Sensitivity: 3) cultural competency, 4) socio economic
awareness; (iii) Interpersonal Relationships: 5) fairness, 6) courtesy, 7) reliability, 8) expectation management; and (iv)
Clinical Capabilities: 9) professional competency, 10) timeliness, 11) coordination, 12) completeness, 13) engagement, 14)
standards conformance, 15) customizability, 16) monitorability, and 17) accountability. An example of a KPID in the
Economical Value category is aordability; participants expressed that home care delivery costs must be controlled in order
to make it feasible for patients and their payers(CMS), and to maintain the HHA’s sustainability as a business. A participant
commented that "Access to home care should not be hindered by ability to pay. The care should be both nancially and
geographically accessible" (participant 6). In the Sociocultural Sensitivity category, many participants indicated that home
care sta should develop cultural awareness to respond to various cultural needs of patients and caregivers, including their
religions and languages. A participant stated: "If unfamiliar with cultural preferences and customs, case manager should
research before start of care then speak to patient and family” (participant 15). Participants also emphasized Interpersonal
Relationships by considering that home care professionals should show courtesy towards patients and caregivers; as one
participant explains: "Our care must be friendly and supportive" (participant 20).
Discussion: Results indicate that performance improvement in HHAs is a lot more complicated than simply assessing
whether certain clinical tasks are performed. It is important for HHAs to develop a broader view of what should be done as
part of the overall care delivery process; Only then can an HHA truly have an impact on patient outcomes. For example,
given the nature of home care, attention to social and cultural issues is paramount to delivering patient-centered care. In
addition, it is essential that there be sensitivity to so cioeconomic status of patients, where they live, community resources,
family and caregiver involvement, as well as social support systems. HHAs can evaluate their health IT adoption strategy and
current solutions to assess if and how they help them improve any of the KPIDs. For example, to improve the professional
competency of providers, health IT solutions should provide online and electronic training to enable providers to stay up-to-
date on the latest evidence-based care practices.
Conclusion: KPIDs identied in this study can help HHAs in their customized QAPI initiatives by providing useful starting
points. Through the identication of relevant domains, and important information required for quality improvement, health
IT strategies can be better aligned with HHA QAPI activities. HHAs should evaluate their health IT adoption strategies
University of Maryland, Baltimore County
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H3IT: Home Healthcare, Hospice, and Information Technology Conference Nashville, TN, 2015
in light of this evidence and decide whether their health IT solutions help them improve the previously-mentioned domains.
Therefore, our results should be immediately relevant, intriguing, and applicable to the home care industry and policy makers.
In the future, results from this study could lead to a framework for developing a set of performance measures for KPIDs. We
recognize that before CMS or accreditation bodies require the KPID measures, there is more work that needs to be done to
validate whether the measures do have an impact on patient outcomes.
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