Operation and challenges of home-based medical practices in the US: findings from six aggregated case studies

Norman, Gregory J.; Orton, K; Wade, Amy; Morris, Alvin L.; Slaboda, Jill C.

doi:10.1186/s12913-018-2855-x

Cited by 22 publications

(44 citation statements)

References 20 publications

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“…Participants highly valued health‐care providers who listened closely to patients and displayed genuine care and concern. Coordinated HBPC where patients’ goals and preferences are clear, patients are provided community resources, and collaboration exists between health‐care providers, social workers and medical equipment agencies has the potential to circumvent office‐based care issues 15‐18,26,34,44 . However, study participants held diverse opinions about home‐based primary care.…”

Section: Discussionmentioning

confidence: 99%

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A qualitative study of health‐care experiences and challenges faced by ageing homebound adults

Cheng

Batten

Cornwell³

et al. 2020

Health Expectations

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Background The ageing of the global population is associated with an increasing prevalence of chronic diseases and functional impairments, resulting in a greater proportion of homebound individuals. Objective To examine the health‐care experiences of older homebound adults who have not previously received home‐based primary care (HBPC). To explore their impressions of this method of care. Design Cross‐sectional qualitative study using semi‐structured interviews. Setting and Participants 18 older homebound individuals in Central Virginia. Results Our findings revealed that homebound individuals faced significant health challenges, including pain resulting from various comorbidities. They felt that their mobility was restricted by their physical conditions and transportation challenges. These were major barriers to social outings and health‐care access. Participants left their homes infrequently and typically with assistance. Regarding office‐based care, participants were concerned about long wait times and making timely appointments. Some thought that HBPC would be convenient and could result in better quality care; however, others believed that the structure of the health‐care system and its focus on efficiency would not permit routine HBPC. Discussion and Conclusions Older homebound adults in this study faced high burdens of disease, a lack of mobility and difficulty accessing quality health care. Our observations may help researchers and clinicians better understand the health‐care experiences and personal opinions of older homebound individuals, informing the development of effective and empathetic home‐based care. Participant responses illuminated a need for education about HBPC. We must improve health‐care delivery and develop comprehensive, patient‐centered HBPC to meet the needs of homebound individuals.

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Section: Discussionmentioning

confidence: 99%

“…HBPC produces high patient satisfaction rates, lower hospitalization durations, lower readmissions, decreased emergency department visits, and lower Medicare costs with similar survival outcomes 3,7,9,16‐22 . There is currently a shortage of HBPC providers compared to the number of individuals in need 7,9,16 …”

Section: Introductionmentioning

confidence: 99%

A qualitative study of health‐care experiences and challenges faced by ageing homebound adults

Cheng

Batten

Cornwell³

et al. 2020

Health Expectations

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“…Recruiting retired nurses could increase the supply of providers [28]. Using telemedicine technology could make HHC more accessible [29]. 2) Healthcare service content should be expanded to satisfy the multifaceted demands of homebound adults.…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Study of Healthcare Experiences Among Chinese Homebound Adults Receiving Home Health Care Services

Zhou

Cheng

Wang

et al. 2020

Preprint

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Background: Home health care services (HHC) are emerging in China to meet increased healthcare needs among the homebound population, but research examining the efficiency and effectiveness of this new care model is rare. This study aimed to investigate care recipients’ experiences with HHC and areas for improvement in China.Methods: This research was a qualitative study based on semi-structured interviews. Qualitative data were collected from homebound adults living in Jinan, Zhangqiu, and Shanghai, China. A sample of 17 homebound participants aged 45 or older (mean age = 76) who have received home-based clinical care were recruited. Colaizzi’s descriptive phenomenological method was used to generate qualitative codes and identify themes.Results: The evaluations of participants’ experiences with HHC yielded both positive and negative aspects. Positive experiences included: 1) the healthcare delivery method was convenient for homebound older adults; 2) health problems could be detected in a timely manner because doctors visited regularly; 3) home care providers had better bedside manners and technical skills than did hospital-based providers; 4) medical insurance typically covered the cost of home care services. Areas that could potentially be improved included: 1) the scope of HHC services was too limited to meet all the needs of homebound older adults; 2) the visit time was too short; 3) healthcare providers’ technical skills varied greatly.Conclusions: Findings from this study suggested that the HHC model benefited Chinese older adults, primarily homebound adults, in terms of convenience and affordability. There are opportunities to expand the scope of home health care services and improve the quality of care. Policymakers may consider providing more resources and incentives to enhance HHC in China. Educational programs may be created to train more HHC providers and improve their technical skills.Trial registration: Not applicable

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“…Adopting telehealth may be a potential best practice for improving efficiency and scalability, which, in turn, may address two significant challenges for HBPC programs: that community needs often exceed program capacity and the necessity of providing urgent visits [33]. Previous research conducted in non-HBPC settings has shown that provider acceptance of telehealth is a crucial determinant of successful adoption and sustainability [19,21].…”

Section: Discussionmentioning

confidence: 99%

Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study

Kozikowski¹,

Shotwell²,

Wool³

et al. 2019

JMIR Aging

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Background Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs. Objective The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to increase the reach of HBPC to more homebound patients. Methods We collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens. Results Four broad themes—pros and cons of scaling, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship—and multiple second-level themes emerged from the analysis. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient’s care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth. Conclusions These findings suggest the importance of considering the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program will hopefully facilitate the optimal integration of telehealth innovations.

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Operation and challenges of home-based medical practices in the US: findings from six aggregated case studies

Cited by 22 publications

References 20 publications

A qualitative study of health‐care experiences and challenges faced by ageing homebound adults

A qualitative study of health‐care experiences and challenges faced by ageing homebound adults

A Qualitative Study of Healthcare Experiences Among Chinese Homebound Adults Receiving Home Health Care Services

Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study

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