Improving the outcomes of home care services in New York State: a national model.

Despite the rapid growth of Medicaid home care services, no uniform system for measuring and improving the quality of these services has been implemented on a large scale. The Personal and Skilled Care Outcomes (PESO) data set was developed to provide non-Medicare-certified home care agencies with a data set to support the systematic assessment and improvement of patient outcomes. This article describes the key features of the data set and outlines ways that a PESO-based outcome-based quality improvement process can be refined to accommodate the unique mix of services provided by home care agencies serving the Medicaid and private-pay populations.

A study of reliability and burden of home health assessment using OASIS.

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.

A Study of Reliability and Burden of Home Health Assessment Using OASIS.

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.

New tool to use with patient tally reports.

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.

Using the new OASIS-based reports in OBQI.

OASIS-derived outcome reports first became available to home care agencies in February 2002 and depicted the agency's current (observed) outcome achievement rate as compared to a reference (predicted) rate on 41 separate outcomes. New three-bar reports are now available that allow agencies to evaluate their current outcome rates against their previous year's rates and a reference rate. This article compares the newly-available three-bar reports with the prior two-bar reports, including information provided in those reports in the OBQI process.

Developing and implementing a plan of action to improve care. The basics.

Once agencies have completed a process-of-care investigation, the next step of OBQI is the development and implementation of a plan of action to improve care. In this article, the authors share strategies for developing, implementing, and monitoring a successful plan of action and describe how pilot agencies developed their own action plan.

The process-of-care investigation. The basics.

The risk-adjusted and descriptive outcome report provides a foundation for Outcome-Based Quality Improvement (OBQI). This article describes the steps of the process-of-care investigation that will begin once target outcomes are selected.

A basic and practical overview of the six steps of outcome-based quality improvement. Selecting target outcomes: the basics.

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.

A basic and practical overview of the six steps of outcome-based quality improvement. Interpreting outcome reports: the basics.

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.

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).

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.