A Conceptual Framework for Clinical Quality Oversight in Telehealth-Enabled Home-Based Urgent Care

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.