The National Home-Based Primary Care Learning Network: A Practice-Based Quality Improvement and Research Network |
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| Institution: | 1. Division of Geriatric Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA;2. Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA;3. Harvard Medical School, Boston, MA, USA;4. University of Texas Southwestern Medical Center, Dallas, TX, USA;5. Baylor College of Medicine, Houston, TX, USA;6. Advisor to Improvers and Learners, Saint Paul, MN, USA;7. University of Pennsylvania Health System, Philadelphia, PA, USA;8. Connolly Hospital, Dublin, Ireland;1. School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia;2. Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia;3. Medical School, The University of Western Australia, Crawley, Western Australia, Australia;4. Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia;5. Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia;6. Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia;1. Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA;2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA;3. Department of Economics, Farmer School of Business, Miami University, Oxford, OH, USA;4. Scripps Gerontology Center, Miami University, Oxford, OH, USA;5. Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA;6. Division of Geriatrics, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA;7. Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, NY, USA;1. Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan;2. Tokyo Fire Department, Tokyo, Japan;1. Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA;2. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;3. MGH Institute of Health Professions, Boston, MA, USA;4. Meyers Primary Care Institute, Worcester, MA, USA;5. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA;1. Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland;2. Balgrist University Hospital, Department of Neurology and Neurophysiology, Zurich, and University of Zurich, Zurich, Switzerland;3. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA;4. Department of Gastroenterology, University Hospital Zurich and University of Zurich, Zurich, Switzerland;5. Department of Radiation Oncology and Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Zurich, Switzerland;6. University of Zurich, University Hospital Zurich, Center of Clinical Nursing Science, Switzerland;7. Marcus Institute of Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, MA, USA |
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| Abstract: | Home-based primary care (HBPC) provides interdisciplinary, comprehensive care at home for homebound older adults and has been largely excluded from the national conversation on care quality and quality improvement. In this Pragmatic Innovations article, we describe the work of the National HBPC Learning Network (LN), which focuses on fostering a continuous learning culture among HBPC practices to improve practice quality, elevate the field of HBPC, and create a community of continuous growth and quality of care accountability. The LN recruits HBPC practices in waves of 9 to 10 practices. It currently comprises 38 HBPC practices that care for 58,000 patients across 25 states (approximately 26% of all patients receiving HBPC in the United States). In a Kickoff meeting, the HBPC practices in each wave are instructed in the basics of quality improvement, develop project aim statements and their first plan-do-study-act cycle, receive an introduction to the LN quality improvement software platform, and review plans for LN engagement. Each month, practices submit updates and receive real-time feedback on their quality improvement work. Monthly virtual workshops are held with all practices that include sharing results of a “1-minute survey” (a monthly 1-to 3-question survey sent to all LN participants on a topic relevant to HBPC practices), a didactic and discussion related to the 1-minute survey topic, and interactive progress updates from LN participants regarding their quality improvement work. Each wave ends with “Moving-up Day,” where practices report on their overall project and reflect on how their practice has changed as a result of the LN. LN practices have addressed and improved performance in multiple HBPC-related quality areas including assessment of functional status and cognitive impairment, falls prevention, advanced care planning, COVID-19 vaccination, and others. We present case studies of 3 LN practices and how LN participation strengthened their practices. |
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| Keywords: | Home-based primary care quality improvement learning network |
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