Operation and Challenges of Home-Based Medical Practices in the US: Findings from Six Aggregated Case Studies

Gregory J. Norman
Kristann Orton
Amy Wade
Andrea M. Morris
Jill C. Slaboda
Peer-Reviewed Article
January 2018
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Strategies for home-based primary care (HBPC) practices to improve efficiency and support program growth based on qualitative research.


HBPC is a model of care that provides in-home treatment to medically complex, homebound older adults. HBPC programs vary widely in structure, size, care team composition, and approach to at-home care delivery. This qualitative study assesses six practices across the United States to explore the operations of HBPC programs and identify potential best practices.


This study describes the team composition and roles, patient identification for enrollment, and technology and urgent care approaches across these six HBPC practices. HBPC staff and providers also identified common challenges for their work in delivering in-home care for frail older adults. These challenges included provider retention, unmet service demand, electronic medical records integration, and travel routes to efficiently visit patients. Team-based care with specialized personnel can support improved care coordination and support provider retention, but small HBPC practices often have difficulty adding more staff under reimbursement in fee-for-service Medicare, and instead have physicians perform multiple non-clinical roles. There is unmet need across HBPC programs, especially in rural areas. While not all HBPC programs provide urgent care services, the use of community paramedicine can support HBPC programs in developing sustainable staffing models to respond to urgent care calls.


Lessons from this qualitative study can inform other HBPC programs on best practices to address common challenges. Some best practices included using a multidisciplinary care team, implementing telemedicine, and practicing community paramedicine.

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