The Benchmark Email

...benchmarks, strategies and ideas for improving your agency
A service of Fazzi Associates, Inc.

February 23, 2006

Most Difficult Outcome Measure

Question:The chart you recently shared with the number of agencies reaching the top 10% of Home Health Compare is very interesting. What is the most difficult outcome measure for an agency to reach the top 10%?

Answer: Home Health Compare quality measures went through a change this past fall. The quality outcomes measuring improvement in upper body dressing, stabilization in bathing, improvement in toileting, and improvement in confusion frequency were dropped. In their place, 3 new outcomes were added to the list: improvement in dyspnea, improvement in urinary incontinence, and discharge to the community. Improvement in status of surgical wounds is planned for a future release. While agencies have been monitoring these new outcomes from their OBQI reports, the change has been a challenge for some agencies. Specifically, demonstrating an improvement in dyspnea has not been easy for many. Fazzi Associate’s Quality Improvement department analyzed the results of those agencies in the bottom 10% of Home Health Compare. The analysis revealed that this quality outcome is most frequently below the national average in comparison with the other 9 measures for this group.

If your results are not within the top 10% group, start your review with the source document – the OASIS assessment. Fazzi Associates has conducted over 3 thousand OASIS audits which have identified data integrity issues in about 60% of the records reviewed. In order to improve your clinician’s understanding of this particular outcome, “test it”, instructs Rhonda Will, RN BS, Senior Consultant with Fazzi Associates. Will suggests asking the clinician to determine at what level the patient becomes Shortness of Breath (SOB) by asking the patient to walk and simulate activities of daily living (ADL’s) during the assessment. Using this strategy will help determine when the patient becomes SOB which is what this OASIS question (M0490) is asking.

“Also, don’t forget to teach the staff that improvement in end result outcomes is determined when the value assigned to the OASIS question is lower (less impaired) at discharge in comparison to the value assigned at Start of Care (SOC) or Resumption of Care (ROC)”, reminds Gina Mazza, RN BSN, Director of BestWorks®. Therefore, solving inter- rater reliability issues between the SOC, ROC, and Discharge assessments will improve data integrity results as well.

Once you have determined that the quality outcome results are based on accurate assessments, you can formulate your plan of action. Of course, this strategy is effective for all of your end result outcomes. With a future Pay-for-Performance model based on quality outcomes, consistent and accurate OASIS assessments are imperative to an agency’s success.