There are more than 400 visiting nurse agencies in the country providing care for more than 4 million patients every year. Despite this impressive national network (that has existed for more than 100 years), there is no single or comprehensive source of information about the innovative care management models that have been implemented in home care across the country. Home care has also been under-represented relative to other healthcare settings in the two principal national online resources for clinical practice guidelines and quality measures. In these two clearinghouses, National Guideline Clearinghouse and National Quality Measures Clearinghouse, home care represents only 4% to 6.2% of the measures.

This past year, VNAA was awarded a federal grant from the Department of Health and Human Services/Centers for Disease Control and Prevention that will fund the creation of VNAA's "Chronic Care Management in the Home and Community: Developing a National Clearinghouse for Best Practices Specific to the Needs of the Home Health Patient." Thanks to federal support, VNAA is researching and collecting information on chronic care management models. At the first national meeting on Charting the Course for Home Care Quality (sponsored by the Center for Home Care Policy & Research and the Robert Wood Johnson Foundation), a diverse group of stakeholders identified such a clearinghouse as one of the priority, high-leverage changes that could advance the home care quality agenda.

Diabetes has been selected as the initial condition for the Chronic Care Clearinghouse. Although only 18% of Medicare beneficiaries have diabetes, they account for 32% of Medicare spending. A study released from the Yale Schools of Public Health and Medicine (2005) states that diabetes will be the leading cause of death for Americans during the next 20 years. VNAs alone care for approximately 600,000 patients with diabetes; these patients impose a significant illness and financial burden.

With additional funding, the goal for the Clearinghouse is to include congestive heart failure, chronic obstructive pulmonary disease, and other chronic conditions in the near future. In December 2005, the VNAA assembled a Chronic Care Clearinghouse Expert Panel to review and select topics for best practices and to review material received from home care agencies across the country. The panel is composed of renowned academic and clinical experts from Yale University, Diabetes/Endocrinology Center; VNA of Boston; The Center for Excellence in Home Care Practice and Education at Boston College School of Nursing; Home Health United in Madison, Wisconsin; the Home Care Association of Wisconsin; VNA Care Network Foundation in Massachusetts; and IPRO, a Quality Improvement Organization based in Albany, New York.

The Web site initially will identify "best practices" for home care and provide the information and tools that will assist clinicians in their day-to-day practice. A standardized tool to measure outcomes related to these best practices is being considered. The VNAA Clearinghouse Web site is scheduled to go live in July 2006.

We welcome all home care clinicians to visit and use this site!!

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