Steven H. Landers, MD, MPH
Potential Financial Conflicts of Interest: None disclosed.
Landers SH. National Quality-of-Care Standards in Home-Based Primary Care. Ann Intern Med. 2007;147:432. doi: 10.7326/0003-4819-147-6-200709180-00018
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Published: Ann Intern Med. 2007;147(6):432.
TO THE EDITOR:
Smith and colleagues (1) should be commended for their efforts to introduce quality standards for home-based primary care. Unfortunately, their selection process and choice of indicators overlooked important qualities of elderly patients with chronic illness and the role of home-based primary care. They have exaggerated the importance of narrow, condition-specific guidelines and have shortchanged the value of measuring patient-centered aspects of care. Following these guidelines could lead to lower-quality care as clinician attention is diverted from meeting patient and family goals to focusing on irrelevant checklists.
Home-based primary care has tremendous potential to improve the care of vulnerable elders. In-home care reduces access barriers, provides a holistic view of patients, and demonstrates caring. These characteristics position it as a promising intervention for Medicare's great challenge: the care of elders with multiple coexisting chronic conditions. Eighty percent of Medicare expenses are for the care of patients with 4 or more chronic conditions (2). Beyond the cost, elders with multiple conditions often suffer without medical leadership because care is provided in narrow and rigid categories.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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