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Scholarly Commons > HCA Healthcare Journal > Vol. 7 > Iss. 5 (2026)

 

Keywords

home care; Medicare; palliative care referrals; quality monitoring; telemedicine; safety culture; urgent care

Disciplines

Community Health and Preventive Medicine | Emergency Medicine | Family Medicine | Geriatrics | Health Services Research | Internal Medicine | Palliative Care | Preventive Medicine | Quality Improvement | Rural Health | Telemedicine

Abstract

Background

Home-based urgent care serving frail older adults should aspire to high-quality clinical care with optimal patient outcomes. However, monitoring and ensuring this quality can be challenging. For example, telemedicine and value-based frameworks introduce substantial complexity to clinical quality monitoring.

Purpose

We describe the conceptual framework for a multidimensional quality monitoring program within a national home-based urgent care model.

Framework Description

Medical care was delivered via a multi-state home-based primary, palliative, and urgent care practice serving medically complex Medicare Advantage (MA) populations. Our model of care incorporated distributed clinical and operational teams delivering 24/7 care via telephonic triage, video-enabled encounters, and in-home evaluations. Challenges stemmed from rapid expansion in patient volume and the workforce complexity of a distributed, multistate, 24/7 model.

Implications

In decentralized, telehealth-enabled care environments, effective quality monitoring incorporates several considerations. We endorse developing explicit operational definitions of quality, deliberate diversification of measurement approaches, integrating across organizational domains, and a sustained culture of continuous learning and improvement.

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