Development of Quality Indicators to Address Abuse and Neglect in Home-Based Primary Care and Palliative Care

OBJECTIVES: To develop candidate quality indicators (QIs) for the quality standard of "addressing abuse and neglect" in the setting of home-based medical care. DESIGN: Systematic literature review of both the peer-reviewed and gray literature. SETTING: Home-based primary and palliative care practices. PARTICIPANTS: Homebound community-dwelling older adults. MEASUREMENTS: Articles were identified to inform the development of candidate indicators of the quality by which home-based primary and palliative care practices addressed abuse and neglect. The literature guided the development of patient-level QIs and practice-level quality standards. A technical expert panel (TEP) representing exemplary home-based primary care and palliative care providers then participated in a modified Delphi process to assess the validity and feasibility of each measure and identify candidate QIs suitable for testing in the field. RESULTS: The literature review yielded 4,371 titles and abstracts that were reviewed; 25 publications met final inclusion criteria and informed development of nine candidate QIs. The TEP rated all but one of the nine candidate indicators as having high validity and feasibility. CONCLUSION: Translating the complex problem of addressing abuse and neglect into QIs may ultimately serve to improve care delivered to vulnerable home-limited adults who receive home-based medical care.