How OASIS data quality affects you!

In general, each of these methods require time and energy from staff members and therefore affect both clinicians and the home health agency. Because the assessor is usually a field nurse or therapist, field staff are very vulnerable to a top down audit approach unless staff are included in the development cycle to achieve a non-threatening quality improvement process. Furthermore, an understanding of the research concepts provides agencies with a creative opportunity to develop their own audit processes. In addition, these concepts offer an awareness as to why HCFA may have chosen the specific areas and methods they have recommended to use when identifying errors. HCFA encourages agencies to consider different methodologies and approaches and to use what works best in order to ensure data accuracy. This is one of the first times in which HCFA has given so much latitude to agencies and their staff. It is hoped that this article fosters interest and insight as to why field staff should actively become involved in audit processes that check their skills and accuracy, which directly correlates to such a huge impact on all involved. In order to improve reliability, an agency should try to minimize external sources of variation and standardize the conditions under which measurement occurs. Initial and ongoing training sessions for staff on each of the OASIS data elements can establish higher reliability and can be streamlined and targeted on areas that staff have the most questions and areas that audits indicate high error rates with data inaccuracies. It is important to remember that each OASIS question has been proven to be valid and reliable; therefore, the only variable left is the source, i.e., those who use the instrument to determine where data inaccuracies could be generated (the field assessor, data entry staff, vendor transmitters, etc.). Agencies should develop the audit functions that will best meet their needs, and minimize the workload for all involved in finding these data inaccuracies.

Home care and a bill of rights: past experience, potential implications.

Patient rights legislation is not entirely new. In 1987 Congress passed laws regarding patient rights. At that point, the home care industry experienced some valuable lessons that Congress, government, consumers, and agencies should all consider with future bill of rights.

Characterization of an endotoxemic baboon model of metabolic and organ dysfunction.

An anesthetized endotoxemic baboon model has been developed by infusing 2.0 mg E. coli endotoxin/kg i.v. over 1 hr (n = 7). Animals were monitored for 5-7 days with analyses of: cardiovascular, metabolic, and organ dysfunction; acid base, hemostatic, and hematological alterations; as well as tumor necrosis factor (TNF) and interleukin-6 (IL-6) levels. Pathophysiologies detected at 2 hr included transient decreases in vascular resistance and blood pressure, a 157% increase in blood lactate, and a 90% decrease in circulating neutrophils. Organ dysfunction was not observed until 24 hr and, although thrombocytopenia was prevalent (-72% at 48 hr), disseminated intravascular coagulation (DIC) was not a major pathology. Hematocrit fell 21% by 24 hr and was -41% at 5-7 days. Serum TNF peaked at 90 min (7.8 +/- 0.2 ng/mL) and was undetectable after 3 hr. IL-6 also increased early, peaked at 3 hr (3872 +/- 846 U/mL) and was still detectable at 24 hr. A low mortality primate model of gram-negative sepsis has been developed that is characterized by early cardiovascular and metabolic dysfunction (2-6 hr), late organ dysfunction (24-48 hr), sub-clinical DIC, a prolonged anemia, and a 29% mortality between 48 and 72 hr.

Preclinical evaluation of alpha-1-proteinase inhibitor. Pharmacokinetics and safety studies.

To assess the pharmacodynamics and safety of alpha-1-proteinase inhibitor (human) (A1PI) isolated from pooled human plasma, a series of animal studies was conducted. Using both unlabeled and 125I-labeled A1PI (highly purified), plasma residence time and tissue distribution were determined in rabbits. A catabolic half-life of 48.5 hours was obtained for the labeled material, which agreed well with the antigenic decay (35.5 hours), measured with a specific enzyme-linked immunosorbent assay, and the functional activity decay (38.1 hours), measured antigenically by the ability of resident human A1PI to complex with human neutrophil elastase. No unusual tissue distribution was observed at the first, 24th, or 168th hour of sacrifice. Cynomolgous monkeys received infusions of labeled A1PI and a catabolic half-life of 55.45 hours was obtained; infusion of unlabeled material yielded anticipated plasma recovery and a significant increment in A1PI in bronchial-alveolar lavage fluid, both antigenically and functionally determined. Safety studies assessing acute physiologic response and both acute and subacute toxicity presented no significant adverse effects. We conclude that A1PI (human) presents normal pharmacodynamics and safety and is therefore associated with a wide margin of safety for the intended clinical applications.

Influence of dosage regimen on responses of the arcuate nucleus to subcutaneous injection of a protein hydrolysate.

The effect of administration of a glutamate-containing protein hydrolysate on the arcuate nucleus of 10-day-old mice was studied by two methods. Arcuate nucleus damage resulted when administration was by a single large subcutaneous dose (100 ml/kg). When the same total dose was administered subcutaneously in five small doses (20 ml/kg) over a period of 8 h, the damage to the arcuate nucleus did not occur. The latter method of administration was to simulate a clinical infusion. The results demonstrate that there is no hazard to the arcuate nucleus w-en glutamate-containing protein hydrolysates are administered by infusion.