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A new tool is available for agencies to use with their patient tally reports derived from OASIS data. By using queries submitted to the outcome and case mix tally reports, agencies can select a group of care episodes for follow-up in the process-of-care investigation portion of their outcome enhancement activities. An example of how an agency used the tool to select care episodes for review is provided.

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.

After obtaining the risk-adjusted and descriptive outcome report, the first activity of outcome enhancement involves selecting one or two target outcomes. This article outlines the criteria for target outcomes selection and features a suggested timeline.

Analysis of OASIS data produces several types of agency-level (aggregate) reports. This article describes the components of the risk-adjusted and descriptive outcome report.

Objectives: To evaluate effects on patient outcomes of Outcome-Based Quality Improvement (OBQI), a continuous quality improvement methodology for home health care (HHC)., Design: A quasi-experimental design with prospective pre/post and study/control components within two multiyear demonstration trials (occurring from 1995 to 2000) in which 73 home health agencies implemented OBQI, receiving several annual cycles of outcome reports to evaluate and enhance patient outcomes., Setting: New York and 27 other states., Participants: The study involved 157,548 predominantly older adult patients admitted over 3 years to 54 OBQI agencies from 27 states in the National Demonstration Trial, 105,917 patients admitted over 4 years to 19 OBQI agencies in the New York State Trial, and 248,621 patients admitted over 3 years to non-OBQI control agencies in the 27 demonstration states., Intervention: As a clinical management and administrative intervention, OBQI involves collecting, encoding, and transmitting patient-level health status data to a central source that provides each OBQI agency with a risk-adjusted outcome report comparing the agency's patient outcomes with those from a reference population and with its own outcomes from the prior period. Target outcomes are selected and focused plans of action implemented to change care behaviors. Outcome changes are evaluated through the next report cycle., Measurements: Outcome measures include hospitalization rates and improvement and stabilization outcome rates in functional, physiological, emotional/behavioral, and cognitive health., Results: For the National and New York State Demonstration Trials, the risk-adjusted relative rates of decline in hospitalization of 22% and 26%, respectively, for OBQI patients over the 3-year and 4-year demonstration periods were significant (P <.001) and unparalleled by considerably smaller rates of decline for the non-OBQI patients in the 27 states. The risk-adjusted rates of improvement in OBQI target outcome measures of health status averaged 5% to 7% per year in both demonstration trials and were significantly greater (P <.05) than analogous improvement rates for nontarget comparison outcomes, which averaged about 1% per year., Conclusion: It is feasible to integrate the programmatic, data collection, data transmission, and outcome enhancement components of OBQI into the day-to-day operations of home health agencies. The aggregate findings and the agency-level evidence available from site-specific communications suggest that OBQI had a pervasive effect on outcome improvement for home health patients. OBQI appears to warrant expansion and refinement in HHC and experimentation in other healthcare settings.

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.

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.

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.

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.

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.

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.

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.