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

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

1

, Dari Alhuwail

1

, Robert Rosati

1

I

mproving the quality of healthcare can result in better health outcomes and patient satisfaction while possibly

reducing the overall costs of healthcare.

1

Historically, a number of initiatives were designed and implemented to

improve the quality of home care in the United States.

2

In the future of home care, quality improvement efforts

will continue to take an important role, and health information technology (IT) will be expected to effectively

serve and support such efforts.

3–5

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 fulfill the conditions of participation in Medicare.

6

CMS set the end goal as observable improvements in the quality

measures without providing specific advice about how to improve outcomes through QAPI by acknowledging its difficulty.

Instead, CMS advises HHAs to adopt customized QAPI programs by considering the specific 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.

7–9

The Framework Method,

10–13

used in many research domains including, medicine,

14–16

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

participants.

17

The analysis results were further refined in an online forum and validated at a final meeting.

Results: From the focus group discussions, a well-defined set of 17 KPIDs emerged under four categories, namely, (i)

Economical Value: 1) worthiness, 2) affordability; (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 affordability; 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 financially and

geographically accessible" (participant 6). In the Sociocultural Sensitivity category, many participants indicated that home

care staff 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 identified in this study can help HHAs in their customized QAPI initiatives by providing useful starting

points. Through the identification 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

1

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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