Factors associated with homecare coordination and quality of care: a research protocol for a national multi-center cross-sectional study

Abstract

Introduction The persistent fragmentation of home healthcare reflects inadequate coordination between care providers. Still, while factors at the system (e.g., regulations) and organisational (e.g., work environment) levels crucially influence homecare organisation, coordination and ultimately quality, knowledge of these factors and their relationships in homecare settings remains limited. Objectives This study has three aims: [1] to explore how system-level regulations lead to disparities between homecare agencies’ structures, processes and work environments; [2] to explore how system- and organisation-level factors affect agency-level homecare coordination; and [3] to explore how agency-level care coordination is related to patient-level quality of care. Design and methods This study focuses on a national multi-center cross-sectional survey in Swiss homecare settings. It will target 100 homecare agencies, their employees and clients for recruitment, with data collection period planned from January to June 2021. We will assess regulations and financing mechanisms (via public records), agency characteristics (via agency questionnaire data) and homecare employees’ working environments and coordination activities, as well as staff- and patient-level perceptions of coordination and quality of care (via questionnaires for homecare employees, clients and informal caregivers). All collected data will be subjected to descriptive and multi-level analyses. Discussion The first results are expected by December 2021. Knowledge of factors linked to quality of care is essential to plan and implement quality improvement strategies. This study will help to identify modifiable factors at multiple health system levels that might serve as access points to improve coordination and quality of care.

A social network analysis to explore collaborative practice in home care: research protocol

“…Finally, this study’s findings will be an excellent complement to the study by Möckli et al [ 70 ], which will be carried out in Switzerland at the national level. These authors will focus on the interactions between the macro-, meso-, and micro-factors in care coordination by collecting data from HC agencies [ 70 ]. They also plan to explore care coordination’s associations with the quality of care [ 70 ].…”

“…These authors will focus on the interactions between the macro-, meso-, and micro-factors in care coordination by collecting data from HC agencies [ 70 ]. They also plan to explore care coordination’s associations with the quality of care [ 70 ]. Good coordination seems to be essential for quality HC [ 40 ], so a more detailed analysis of current formal and informal collaborative practice at the micro level is essential.…”

“…That level directly concerns patients and interactions with them [ 54 ], integrating not only the HCGs hired by home care agencies but also independent HCGs. However, independent or free-lance HCGs not employed by HC agencies will not be included in Möckli et al’s study [ 70 ]. Our study, which focuses on both HCGs employed by agencies and HCGs working independently will therefore be of necessary complementary value in exploring and evaluating the strengths and limitations of HC in Switzerland, next to their research.…”

Protocol for evaluating quality and safety for the public through home care nursing in Italy: a multicentre cross-sectional descriptive observational study (AIDOMUS-IT)

“…According to Aase et al ,9 quality care entails having the ‘right competency’ and ability to cooperate with other professional groups, placing the patient at the centre of all the activities. The qualitative dimensions of the structural characteristics (ie, system, documentation) and the ‘soft’ dimensions (ie, dignity, relationships) are important for the conceptualisation of quality by health professionals and should be considered when conducting quality improvement activities also in community care settings 10…”

“…Some of the causes of hospital readmission and inappropriate access to the emergency department (ED) are the interruptions in communication between home care staff, patients and families, and healthcare providers; flaws in healthcare processes; lack of resources including equipment, qualified staff, or on-site providers; and failure to identify home care goals 11. Poor communication and organisation between home care and hospital services lead to negative patient outcomes, poorer health conditions, and unnecessary or incorrect treatment resulting in waste of resources and increased healthcare costs 10…”