Home health care provides a unique service and a sorely needed, unique view of patient and caregivers’ situation and the factors that impact their ability to care for themselves. The home health Nurse, Social Worker, Aide, or Physical Therapist is the provider who sees the bags of old medications, the empty refrigerator, or the long stairs to the one bathroom. Home health care providers are in the homes of patients recently discharged from the hospital or emergency department when the patient is vulnerable to clinical destabilization and readmission. These professionals can interact with the patient and caregivers over the course of 30-60 days to work with them on medication management, lifestyle factors (e.g. a change in diet or mobility), and support the patient’s and caregivers’ knowledge of, and confidence in, their self-care plan. In addition, home health care providers serve as the eyes, ears, and hands for the other care providers, reaching out to the physicians on clinical issues, and to other service providers to get food, transportation, and other assistance to the family. This is no theoretical argument – studies show that home health care can provide substantial improvements for patient outcomes (see this Cleveland Clinic Journal supplement on home health care for a good overview.)
Our health care system needs a robust, reliable and excellent home health care sector to help fix our current ills. For decades, payment incentives did little to encourage investment in the clear benefits that home health care can provide. This is finally starting to change. Initiatives such as Medicare’s Hospital Readmission Reduction Program are forcing providers to focus on outcomes over a longer care cycle, where home health care truly excels.
But as attention begins to shift its way, the home health care industry faces an important challenge. For all the good home health care does and can do, the quality with which it is delivered remains highly variable. It has long been a cottage industry – given far less attention than it deserved. Here’s how Steven H. Landers, MD, MPH, described the situation:
“There is a paucity of medical and health services literature to guide providers and policymakers’ decisions about the right types and approaches to care at home. Maybe this is because academic centers and American medicine became so focused on acute institutional care in the past half century that the home has been overlooked. However, that pendulum is likely swinging back as almost every sober analysis of our current health care environment suggests a need for better care for the chronically ill at home and in the community.”
While the quality improvement movement has gained substantial traction in many corners of health care, it has largely passed by home health care. Home health care desperately needs a foundation of quality improvement, and since 2007, the Home Health Quality Improvement (HHQI) National Campaign has been striving to build just that. HHQI, an initiative of the Center for Medicare and Medicaid Services, offers home health agencies free access to evidence-based tools, timely data reports, online courses, and more.
IHI faculty has been working with HHQI on a new webinar series called “Pave Your Path,” which seeks to train home health care providers to improve quality for their patients. Participants will learn to implement a systematic approach to redesigning and improving their system of care by using well-tested improvement methods. Jane Taylor, Improvement Advisor, and I are faculty for this series. We encourage you to join the next call!
Home health care has tremendous potential to improve the lives of the millions it serves. To date, there have been too few opportunities for the thousands of dedicated professionals to learn how to improve the care they deliver. It’s time we changed that for good, and gave home health care the attention and respect it deserves. What do you think?