Clinical care strategies for high performing (and winning) home health agencies

Background: The CMS-sponsored HHP4P Demonstration project included 570 HHAs from 7 states in 4 regions beginning in CY2008. The evaluation of the Demonstration's effectiveness included the collection of qualitative data to explore what agencies did to achieve higher better patient outcomes. Research Objective: Research question: “What are the quality-related activities that high performing home health agencies engage in to produce superior patient outcomes?” Research Methods: Two groups of eight Treatment group HHAs representing four Census Regions were selected for focused on-site interviews. The first group, visited in 2009, was selected based on their 2007 Home Health Compare performance. The second group, visited in 2010, was selected based on their performance during the first year (CY2008) of the demonstration. Principal Findings: The following provides an outline of quality-related themes identified during the first group (2009) interviews. • Leadership, Administration, and Clinical Teams focus • Multidisciplinary teams; Communication and feedback loops; Technology Adoption • Data driven, Proactive Approach to Quality; Staff education / development • History of strong quality culture and community

Implications for Policy/Practice/Delivery: Quality home health care organizations require strong, effective, and purposeful leadership as the starting point for creating a high-performing home health care organization. The integrated, single-system approach that these leaders created in their organizations created the fertile ground that grew the strong quality culture and multi-disciplinary teams that put patient care first. The comparison/validation approach used in this research spanning two years provides a strong argument in support of an integrated approach to home health care delivery.