Evaluation of quality indicators in home health services delivery

Objective: This study aims to evaluate the performance of home healthcare services (HCS) provided in the Düzce city center throughout 2024, considering dimensions such as accessibility, timeliness, service coverage, and patient experience. The study also aimed to examine the impact of patients' clinical risk indicators (NRS-2002 nutritional risk score, frailty score) and functional dependence levels on the intensity of the services provided. Materials and Methods: The population of this descriptive, retrospective, and crosssectional study, which adopted a descriptive design, consisted of all individuals receiving home healthcare services in Düzce Center in 2024 (N=2511), and the census method was applied. Data for the study were obtained retrospectively using the Home Health Management System (ESYS) for indicators of Health Quality Standards (SKS), the Hospital Information Management System (FONET) for NRS-2002 nutrition risk scores, and unit records for data on other service processes. Patient satisfaction data was evaluated by analyzing the results of surveys administered periodically by the unit and completed by 287 participants recorded in the system. In clinical data, the "Hospital Frailty Risk Score" based on ICD-10 diagnostic codes was used. In addition to descriptive analyzes in statistical evaluations, comparative analyzes were conducted to determine the effect of clinical factors on visit frequency and procedure count. Findings: The mean age of the study group was 75.04±17.09, and 80.8% of the participants were 65 years of age or older. The most common diagnostic groups are, in order, cardiovascular diseases (26.8%), diabetes mellitus (12.3%), and cerebrovascular diseases (10.4%). A total of 11,765 procedures were recorded in service delivery, with probe applications (25.0%) ranking first. When examining quality indicators, the "application response rate within the specified time" was found to be 98.5% throughout the year, while the "planned appointment completion rate within the specified time" was 91.6%. When examining the factors affecting service intensity, it was observed that as the patient's level of dependence increased, the total number of procedures performed and the frequency of visits significantly increased. The analyzes revealed that the main factor significantly increasing the frequency of visits was the patient's level of dependence, and xi that the need for visits also increased significantly in patients with a high nutritional risk (NRS-2002). According to patient experience results obtained from system logs, overall satisfaction is at 92.2%, while the lowest satisfaction is in the area of "test and results information" (85.5%). Conclusion: Düzce province's home healthcare services meet national quality standards at a high level in terms of accessibility and timeliness. A large portion of the service burden is comprised of the elderly, those with cardiovascular and neurological/cerebrovascular diseases, and fully dependent patients. The study revealed that the level of dependence and clinical risk scores (frailty, NRS-2002) are determining factors in service planning. To ensure the sustainability of service quality, it is recommended to standardize outcome reporting processes and transition to a risk-based dynamic resource planning model. Keywords: Home healthcare services; quality indicators; patient experience; NRS-2002; frailty.