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

Bruce Leff, Charlotte M. Carlson, Debras Saliba, Christine Ritchie

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)21-29
Number of pages9
JournalHealth Affairs
Issue number1
StatePublished - 2015

ASJC Scopus subject areas

  • Health Policy


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