Home and Community Care Digest

Home and Community Care Digest December 2004 : 0-0

Information, indicators, and the Internet: The US experience with publishing national home care quality data

Abstract

The Home Health Compare website provides case managers and discharge planners with a tool to help clients select a home health agency by reporting 11 quality of care indicators. The indicators report on improvement in getting around, meeting basic daily needs, reducing medical emergencies, and improvement in mental health. Home health agencies are now better able to manage their own care processes and engage in measurable continuous quality improvement programs.
Background: In the past, a reliable and objective data source was not available to answer rudimentary questions about home health care providers. Home health quality data were made available nationally in November 2003 when the results of comparative quality measures were posted on Medicare's Home Health Compare website (www.medicare.gov) for every Medicare certified home health agency (HHA) in the United States. Eleven quality indicators are now publicly reported. The purpose of publicly reporting quality measures is to help consumers and health professionals choose an agency that best matches the specific needs of the patient. In addition, the indicators are intended to be a tool for HHAs to assist in improving care. This article describes the indicators and reports on some early experiences with using the website.

Methods: The quality measures were developed by the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality. A set of 11 quality measures was selected for public reporting using data from the Outcomes and Assessment Information Set (OASIS). OASIS has been in use since 1999 and is collected at the start of care, at discharge or transfer, at follow-up (60 day recertification), and at resumption of care. These indicators were selected because they represent different aspects of patient outcomes to care provided in the home setting that HHAs could influence. Most of publicly reported indicators are standardized or "risk adjusted" to allow for equal comparisons between HHAs. Risk adjustment is a statistical method to account for differences between HHAs and how sick the clients are (or case-mix) to allow for fair comparison of the data.

Findings: The quality measures represent information about how well home health agencies provide care for their patients. While a patient's health condition may not be expected to improve, the patient may be expected to improve in the areas covered by the quality measures. Improvement in these areas may also be reflective of an agency's willingness to provide essential skilled services, such as therapy or nursing assessment and education, and how well the agency does at providing comprehensive and ongoing assessment of its patients' needs. The indicators are grouped into four broad categories.

Improvement in getting around is measured by: 1) improvement in ambulation, 2) improvement in transferring, 3) improvement in toileting, and 4) improvement in pain interfering with activity. For these measures, higher percentages are generally better. Meeting basic daily needs is measured by: 1) improvement in upper body dressing, 2) improvement in bathing, 3) stabilization in bathing, and 4) improvement in management of oral medication. For these measures, higher percentages are generally better. Reducing patient medical emergencies is measured by: 1) frequency of acute care hospitalizations and 2) provision of emergent care. For these measures, lower percentages are better. Improvement in mental health is measured by improvement in confusion frequency. Generally, higher percentages are considered better.

Conclusions: The Home Health Compare website provides case managers and discharge planners a tool for helping clients select an appropriate home health agency. Reliable information on the quality of care provided by Medicare-certified HHAs is easily accessible on the website. HHAs are now better able to manage their own care processes and engage in measurable continuous quality improvement programs. Regional health authorities, local health networks, and other funding bodies may find these results of use in the move towards outcomes and performance based funding.

Reference: Fermazin M, Canaday MO, Milmine PR, Perron J, Cooper LM. Home health compare. Website offers critical information to consumers, professionals. Lippincott's Case Management, 2004; 9, 89-95.

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