Background: Over the past five years, the home care industry has experienced major changes with the mandatory collection of patient data, a new payment system, and increased scrutiny from the federal government. As a result, home care has become much more attuned to the issue of delivering quality care. To date, little work has been conducted in home health on the issue of quality because of a lack of resources, but industry leaders are now placing greater focus on quality issues to avert reports of inadequate service and poor care.

Purpose: The Partnership for Advancing Quality Homecare (PAQH) seeks to create a mechanism and model for home care organizations to collaborate in order to identify aims for improvement. By joining together home care agencies can also gain access to materials and tools that will allow them to conduct more sophisticated quality improvement activities than they could on their own. Through this process, the participating home care agencies will develop skills to apply innovative methods to implement evidence-based practices to improve care for their patients.

Study Design: PAQH is a national quality improvement initiative that aims to advance the state of home care quality through collaboration among home health care providers. It currently consists of eight home care agencies working with staff from the Center for Home Care Policy and Research and consultants with expertise in quality improvement. In the final two years of the project, the partnership will expand to include additional home care agencies and/or clinical topic focus areas.

PAQH is focusing on improving diabetes care for elderly patients of the eight participating home care agencies by using the Breakthrough Series model, a quality improvement tool developed by the Institute for Healthcare Improvement that has been successfully used in other health care settings. During the 12 month process, teams use the "Plan, Do, Study, Act" cycle, in which they plan an improvement strategy for improving care, do or carry out that strategy, study its effects, and act again with a new strategy that applies the lessons they have learned. All of the teams are trying changes in the three core areas of glycemic control, medication management, and foot care, as well as choosing from some additional areas of diabetes care management. The changes that the teams are using are clinically proven practices that have been adapted for use in the home care setting by an Expert Panel.

PAQH provides teams with ongoing support throughout the effort and team progress is monitored through collection and analysis of data on a monthly basis. The Effort for Quality Improvement and Performance in Home Health Care (EQUIP) project also supports the collaborative efforts of these eight teams. It is hoped that this partnership will spur similar efforts among home care providers in the future.

Publications: PAQH will create a website to serve as a resource for home care quality improvement.

Sponsor: Agency for Healthcare Research and Quality (AHRQ)