Study Identifies Quality of Care Framework for Home-Based Medical Care

October 24, 2018

More than six million adults in the United States are homebound or semi-homebound, and these numbers are certain to grow as our society ages. To help ensure the best possible care for these individuals, a team of researchers has created a quality of care framework for homebound adults. An article in the October issue of JAMDA outlines this framework and how it might serve as a guide for home-based medical care (HBMC) practices.

In “A Quality of Care Framework for Home-Based Medical Care,” the authors discussed their efforts to seek the perspectives of stakeholders ranging from clinicians and administrators to advocacy groups and representatives from professional medical societies. They identified three components of quality in HBMC: provider and practice activities; provider characteristics; and outcomes for patients, caregivers, and providers. Within these three categories, they identified 10 domains and 49 standards for quality in HBMC, including, for example, comprehensive assessment, patient/caregiver education, and provider competency.

The authors reported a “fairly high level” of concordance between all stakeholders regarding the quality domains and standards. The greatest discordance, they said, involved the cost domain. They noted that some stakeholders view utilization and attention to patient/caregiver financial concerns as important quality indicators; others believe that utilization should not even be a quality domain consideration.

The development of an HBMC quality of care framework, the authors said, “is a critical step for the field … with the ascendance of value-based care. Because of the unique nature of their practice, HBMC providers need a quality of care framework, quality measures, and a quality data reporting strategy that is appropriate” to this patient population and care setting.

This work was conducted by researchers at the Division of Geriatrics, Department of Medicine, School of Medicine, University of California, San Francisco; and the Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.