Development of patient-centred home care quality indicators (HC-QIs) for clinical integration of primary care based on the interRAI home care assessment

Background: Only 37% of primary care providers in the Commonwealth Fund are regularly notified by home care providers about important changes in the health status of clients. This service gap is one of many drivers behind the global pursuit of clinical integration, or the coordination of health services across jurisdictions, disciplines, and time. Improving integration can enhance efficiency, quality of care, and patient quality of life. However, it is often measured with unvalidated surveys prone to response and nonresponse biases. Conversely, interRAI quality indicators (QIs) are summary measures of care quality derived directly from standardized and valid clinical assessment instruments. Their superior measurement capabilities may be useful for future clinical integration advancements. Objectives: Our objective is to develop a set of home care QIs (HC-QIs) for the interRAI Home Care (interRAI-HC) instrument for measuring clinical integration between home care and primary care in Canada, Belgium, and other countries where the interRAI-HC is implemented. The following research questions will be answered: (a) which structural, process, and clinical outcome measures are considered key indicators of integration between home care and primary care, (b) which HC-QIs can be developed to measure integration between home care and primary care using the interRAI-HC dataset, (c) what is the state of integration between home care and primary care based on the HC-QIs, and (d) what is the relationship between the HC-QIs and relevant client outcomes (e.g., infections, falls, hospital visits)? Methodology: I will be carrying out a three-year mixed-methods study to achieve the objective. This study will be preceded by a realist review on existing interventions for person-centered care in community care settings and a research protocol following the World Health Organization recommended format. The first step of HC-QI development will be to identify at least 10 candidate HC-QIs based on knowledge gained from preliminary research I conducted, the realist review, and exploratory data analysis of available items in the interRAI-HC. Next, multiple diverse panels of 10 to 18 primary care providers, home care personnel, and home care clients (and caregivers) with high-frequency primary care use from Canada, Belgium, and other countries using the interRAI-HC (TBD) will be purposively recruited to participate in a Delphi process. Participants will complete short questionnaires online and rank the list of candidate HC-QIs in a consensus building process. After data cleaning and aggregation, the top three nominated HC-QIs will be risk adjusted with SAS® University Edition. Multivariate logistic regression and direct stratification will be performed to produce a covariate adjustment equation for each HC-QI. Potential covariates may include any combination of characteristics captured by the interRAI-HC. Estimates from these equations will then be pooled and weighted to generate the final risk-adjusted HC-QIs for Delphi panel review. Finally, descriptive statistics and logistic regression will be used to describe the current state of integration within the research settings and to identify associations between the HC-QIs and relevant outcomes. Contributions: The developed HC-QIs will be useful for health care organizations and clinicians to accurately measure, benchmark, and compare primary care clinical integration among home care organizations. This will support their efforts in quality improvement. This study will also offer high-quality information and a means to obtain information on the status of clinical integration for research purposes. For instance, researchers will be better able to investigate associations between clinical integration and factors like race, gender, and disability, thus highlighting gaps in the health system and supporting further system improvement. Infographics, webinars, and other strategies will be harnessed to ensure appropriate knowledge translation of the research findings and implications.