Identifying cost-based quality and performance indicators for home care: a modified delphi method study

BackgroundThis study, part of a multi-study program, aimed to identify a core set of cost-based quality and performance indicators using a modified Delphi research approach. Conceptually, this core set of cost-based indicators is intended for use within a broader health system performance framework for evaluating home care programming in Canada.MethodsThis study used findings from a recently published scoping review identifying 34 cost-focused home care program PQIs. A purposive and snowball technique was employed to recruit a national panel of system-level operational and content experts in home care. We collected data through progressive surveys and engagement sessions. In the first round of surveying, the panel scored each indicator on Importance, Actionable, and Interpretable criteria. The panel set the second round of ranking the remaining indicators' consensus criteria. The panel ranked by importance their top five indicators from operational and system perspectives. Indicators selected by over 50% of the panel were accepted as consensus.ResultsWe identified 13 panellists. 12 completed the first round which identified that 30 met the predetermined inclusion criteria. Eight completed the ranking exercise, with one of the eight completing one of two components. The second round resulted in three PQIs meeting the consensus criteria: one operational and two systems-policy-focused. The PQIs: "Average cost per day per home care client," "Home care service cost (mean) per home care client 1y, 3y and 7y per health authority and provincially and nationally", and "Home care funding as a percent of overall health care expenditures."ConclusionsThe findings from this study offer a crucial foundation for assessing operational and health system outcomes. Notably, this research pioneers identifying key cost-based PQIs through a national expert panel and modified Delphi methodology. This study contributes to the literature on PQIs for home care and provides a basis for future research and practice. These selected PQIs should be applied to future research to test their applicability and validity within home care programming and outcomes. Researchers should apply these selected PQIs in future studies to evaluate their applicability and validity within home care programming and outcomes. This study aimed to identify a set of financial performance and quality indicators (PQIs) for evaluating home care in Canada. The researchers used a modified multi-phased Delphi research approach with endorsed consensus on three PQIs from the 34 reviewed. One PQI is operational, while the other two are systems-policy-focused.This study was motivated by the need to measure and improve the financial sustainability and efficiency of home care services in Canada. It contributes to the literature on PQIs for home care and provides a basis for future research and practice.This research is novel as it is the first to identify key cost-based PQIs through a national expert panel and modified Delphi methodology for use within a broader health system measurement framework, such as the Institute for Healthcare Improvement Quadruple Aim framework.The indicators identified in this study may provide an essential foundation for measuring operational and health system outcomes and require further engagement at local and regional levels, further development, and conceptual application within established health system performance frameworks.Evaluating the potential adoption and implementation of evidence-based PQIs is essential to measuring and improving home care system programming, including indicators reflective of the acceptability and potential usefulness of measures by population groups as an important future step.