Robert E. Schlenker

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).

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.

Practice Variations in Home Health Care

ABSTRACT Wide variation in Medicare home care utilization became apparent in the 1990s. This study examined the impact of patient, provider, agency, and market factors on five measures of home care practice. Data were collected at 44 agencies in eight states. The final analysis sample included 732 home care episodes for which longitudinal patient data were available. Results indicated that patient factors, such as complexity and functional status, were important predictors of the care a patient received. Agency and market characteristics also strongly influenced care practices. Characteristics of the care providers, on the other hand, exerted only minimal influence.

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.

Measuring healthcare outcomes to improve quality of care across post--acute care provider settings.

Post-acute care (PAC) occurs in a variety of settings—skilled nursing facilities (nursing homes), rehabilitation facilities, and home health agencies. To evaluate the impact of care processes on clinical outcomes and implement changes designed to improve outcomes, one must begin by measuring outcomes in a valid, reliable manner that allows for comparisons to reference or benchmarking data. Currently, several data sets exist in PAC settings for the purpose of outcome measurement. However, there is a need for comparable information across settings to ensure the quality and continuity of care. This article reviews various existing data sets used in PAC settings, examines ongoing projects to create a single set of measures, and suggests some directions for future research.

Stroke Rehabilitation in Nursing Homes

Increasing numbers of stroke patients with profound functional, psychological, and cognitive impairments are receiving rehabilitation in Medicare skilled nursing facilities. These facilities vary substantially in the patients they admit, the volume and intensity of therapy they provide, and the outcomes they achieve. Facilities with an orientation toward rehabilitation and community discharge providing more intensive therapy services by a wider range of skilled professionals have better outcomes.

Outcome-based continuous quality improvement as a financial strategy for home health care agencies

Rapid growth in home health care has led to heightened attention by third-party payers and regulators. Increasingly home health agencies (HHAs) must demonstrate the value of their serv ices. A major concurrent trend within the industry and at the federal level is toward incorporat ing standardized outcome measures in the continuous quality improvement (CQI) programs in HHAs. We suggest that in addition to improving quality, outcome-based CQI can help a HHA demonstrate the value of its services, improve the cost-effectiveness of its care provision, and thereby strengthen its financial viability. Key words: continuous quality improvement, finan cial strategy, outcome measurement