Kathryn S. Crisler

Improving Patient Outcomes of Home Health Care: Findings from Two Demonstration Trials of Outcome-Based Quality Improvement

OBJECTIVES: To evaluate effects on patient outcomes of Outcome‐Based Quality Improvement (OBQI), a continuous quality improvement methodology for home health care (HHC).

A study of reliability and burden of home health assessment using OASIS.

ABSTRACT The Outcome and Assessment Information Set (OASIS) is used for outcome reporting, quality improvement, and case mix adjustment of per-episode payment for home health care. The research described here addresses interrater reliability of OASIS items and compares clinician time required to complete patient assessment with and without OASIS. Interrater reliability for OASIS data items was estimated using independent assessments by two clinicians for a sample of 66 patients. Incremental assessment time due to OASIS was estimated using interview data from two agency-matched groups of clinical care providers-one group who used OASIS in the assessment and a second group whose assessment did not include OASIS items. Interrater reliability is excellent (kappa > .80) for many OASIS items and substantial (kappa > 0.60) for most items. The reported time required to complete an assessment with OASIS did not differ from the time required for a comparable assessment without OASIS. The results of this study are being used to guide developmental efforts to improve OASIS items. They can also be informative to home health care agencies when interpreting OASIS-based outcome and case mix reports.

Outcomes across the care continuum. Home health care.

OBJECTIVES This article describes one approach to measuring outcomes across the continuum of care. METHODS Development and testing of the outcome-based quality-improvement methodology as developed by the University of Colorado Center for Health Services Research in Denver, Colorado are summarized. RESULTS Reliable and valid measures for home health care covering end results (pure outcome), intermediate results (instrumental outcome), and use (proxy outcome) were developed and are useful in demonstrating patient improvement or stabilization as well as decline. Further, these measures can be aggregated by agency and, with appropriate severity or risk adjustment, can be used to compare outcomes over time and across agencies. CONCLUSIONS National testing of the methodology is currently ongoing, with refinements underway in measures, risk adjustment, and operational implementation.

Assessing and Assuring the Quality of Home Health Care: A Conceptual Framework

Increased use of home care services, and the provision of more sophisticated care to acutely ill patients, have prompted concern about quality assurance in home settings. A conceptual framework is proposed to assess home health-care quality based on two premises: outcome, process, and structural measures, first, are required to evaluate quality accurately; classification of patients into quality indicator groups (QUIGs), second, permits specification and use of more practical and valid quality measures. The framework may prove useful because measures are related directly to patient conditions, services rendered, and treatment objectives. Further reliability and validity testing of the QUIGs and a system of operational quality measures are currently underway.

Outcome-based quality improvement in home health care: the OASIS indicators.

The outcomes movement in home health care is expanding rapidly, with strong support from both the industry and Medicare. The Federal government has proposed requiring all Medicare-certified agencies to collect data items from the Outcome and Assessment Information Set (OASIS) to form the basis for standardized risk-adjusted outcome reporting as part of a systematic outcome-based quality improvement (OBQI) approach. In addition to contributing to improving patient outcomes, OASIS data items, when combined with other assessment information, utilization data, and cost information, can provide home health care agencies with a powerful integrated information set for internal management and strategic planning.

Outcome-Based Quality Improvement in the Information Age

The outcomes movement in home health care is expanding rapidly, with strong support from both the industry and Medicare. The Federal government has proposed requiring all Medicare-certified agencies to collect data items from the Outcome and Assessment Information Set (OASIS) to form the basis for standardized riskadjusted outcome reporting as part of a systematic outcome-based quality improvement (OBQI) approach. In addition to contributing to improving patient outcomes, OASIS data items, when combined with other assessment information, utilization data, and cost information, can provide home health care agencies with a powerful integrated information set for internal management and strategic planning.

Using case mix and adverse event outcome reports for outcome-based quality monitoring.

The OBQM process is similar to many of the QI/PI processes that agencies have used in the past. The Adverse Event Outcome and Cse Mix Reports, based on OASIS data, provide agencies with clinical out come data that can be used to improve quality of care. The reposts are a first step in the effort to bring the home care industry to a new era of using patient-centered data as the basis for improving services.

Using OASIS for outcome-based quality improvement.

OASIS was developed for the purpose of measuring and enhancing outcomes of patients receiving home health services. OASIS-derived outcome reports provide a foundation of Outcome-Based Quality Improvement (OBQI). This article describes the OBQI process and provides two case studies to illustrate how agencies can use OBQI to enhance patient care.

We've collected the OASIS data, now what?

The OASIS data set provides home care agencies with well-tested items for the collection of patient health status and outcome data. Illustrative examples of some of the OASIS-derived reports that agencies participating in demonstration projects received are presented. By understanding these reports, clinicians can see how the information they collect is presented in reports and can better understand the importance of collecting complete and accurate data.

Integrating OASIS data collection into a comprehensive assessment.

OASIS should not be used as a survey tool; rather, it should be integrated into a comprehensive assessment. It is almost never appropriate to simply read OASIS questions verbatim to patients and expect them to name the letter of the response. This article provides strategies for collecting OASIS data as part of a routine patient comprehensive assessment.