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Health Aff (Millwood). 2015 Jan;34(1):21-9. doi: 10.1377/hlthaff.2014.1008.

The invisible homebound: setting quality-of-care standards for home-based primary and palliative care.

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Bruce Leff ( is a professor of medicine at the Johns Hopkins University School of Medicine, in Baltimore, Maryland.
Charlotte M. Carlson is an associate medical director at On Lok Senior Health Services, in San Francisco, California.
Debra Saliba is director of the University of California, Los Angeles, Borun Center and a research physician in the Veterans Affairs Greater Los Angeles Healthcare System.
Christine Ritchie is a professor in the Department of Medicine at the University of California, San Francisco.


Approximately four million adults in the United States are homebound, and many of them cannot access office-based primary care. Home-based medical care can improve outcomes and reduce health care costs, but this care operates in a quality measurement desert, having been largely left out of the national conversation on care quality. To address this shortcoming, two of the authors created the National Home-Based Primary and Palliative Care Network, an organization whose members include exemplary home-based medical practices, professional societies, and patient advocacy groups. This article describes the current status of home-based medical care in the United States and offers a brief narrative of a fictional homebound patient and the health events and fragmented care she faces. The article then describes the network's quality-of-care framework, which includes ten quality-of-care domains, thirty-two standards, and twenty quality indicators that are being tested in the field. The same two authors also developed a practice-based registry that will be used for quality-of-care benchmarking, practice-based quality improvement, performance reporting, and comparative effectiveness research. Together, these steps should help bring home-based medical care further into the mainstream of US health care.


Health Reform; Home; Organization and Delivery of Care; Quality Of Care; Special Populations

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[Indexed for MEDLINE]

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