ABSTRACT
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.
Subject(s)
Guidelines as Topic , Home Care Services/standards , Outcome Assessment, Health Care/standards , Quality Indicators, Health Care , Diagnosis-Related Groups , Forms and Records Control , Humans , Iatrogenic Disease , Total Quality Management , United StatesABSTRACT
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.
Subject(s)
Home Care Services/standards , Outcome Assessment, Health Care , Total Quality Management/organization & administration , Humans , Organizational Case Studies , United StatesABSTRACT
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.
Subject(s)
Data Collection/methods , Home Care Services/standards , Nursing Assessment , Humans , United StatesABSTRACT
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.
Subject(s)
Home Care Services/standards , Outcome Assessment, Health Care , Quality Assurance, Health Care , Data Collection/methods , Documentation , Health Status Indicators , Humans , Nursing Assessment , Organizational Case Studies , United StatesABSTRACT
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.
Subject(s)
Home Care Services/standards , Quality Indicators, Health Care , Total Quality Management , Centers for Medicare and Medicaid Services, U.S. , Delivery of Health Care, Integrated/organization & administration , Health Services Research/methods , Home Care Services/economics , Information Systems , Managed Care Programs , Medicare/legislation & jurisprudence , Outcome Assessment, Health Care/standards , Policy Making , Prospective Payment System , United StatesABSTRACT
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.
Subject(s)
Home Care Services/standards , Medicare/standards , Outcome Assessment, Health Care/methods , Quality Indicators, Health Care , Aged , Data Collection/methods , Humans , Risk Assessment , Total Quality Management , United StatesABSTRACT
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.
Subject(s)
Health Services Research/methods , Home Care Services/standards , Outcome Assessment, Health Care/methods , Continuity of Patient Care/organization & administration , Continuity of Patient Care/standards , Delivery of Health Care, Integrated/organization & administration , Delivery of Health Care, Integrated/standards , Forecasting , Home Care Services/organization & administration , Humans , Medicare , Patient Care Management , Quality of Health Care , Severity of Illness Index , United StatesABSTRACT
The utility of examining the effectiveness of home care is illustrated by selected examples and applications. The growth rate of home care over the past decade, questions regarding the possibly substantial differences between the quality of home care in rural and urban America, and empirical evidence that suggests inferior quality of home care for health maintenance organization patients support the need for measuring and monitoring outcomes of home care. The conclusions of a research program targeted at developing a system of outcome measures for home care, and the resulting national demonstration program to implement and refine that system, are summarized.
Subject(s)
Home Care Services/standards , Quality Assurance, Health Care , Aged , Humans , United StatesABSTRACT
A system of outcome measures of service quality was developed and tested. The findings of this project will provide a framework for moving forward with outcome-based quality improvement in home care. Using outcome measures will permit agencies to analyze their performance in terms of effectiveness of care.
Subject(s)
Health Services Research , Home Care Services/standards , Outcome Assessment, Health Care/standards , Forms and Records Control , Medical Records , Methods , United StatesABSTRACT
The growth in home health care in the United States since 1970, and the exponential increase in the provision of Medicare-covered home health services over the past 5 years, underscores the critical need to assess the effectiveness of home health care in our society. This article presents conceptual and applied topics and approaches involved in assessing effectiveness through measuring the outcomes of home health care. Definitions are provided for a number of terms that relate to quality of care, outcome measures, risk adjustment, and quality assurance (QA) in home health care. The goal is to provide an overview of a potential systemwide approach to outcome-based QA that has its basis in a partnership between the home health industry and payers or regulators.
Subject(s)
Home Care Services/standards , Medicare/standards , Outcome Assessment, Health Care/organization & administration , Quality Assurance, Health Care/organization & administration , Data Collection , Evaluation Studies as Topic , Health Services Research , Health Status , Home Care Services/statistics & numerical data , Humans , Medicare/statistics & numerical data , Models, Theoretical , Outcome Assessment, Health Care/statistics & numerical data , Program Development , Quality Assurance, Health Care/statistics & numerical data , Quality of Life , Research Design , Risk Assessment , United StatesSubject(s)
Health Services Research , Home Care Services/standards , Quality Assurance, Health Care/organization & administration , Acute Disease/classification , Chronic Disease/classification , Colorado , Humans , Outcome Assessment, Health Care , Pilot Projects , Program Development , Severity of Illness Index , United StatesABSTRACT
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.