Researchers Identify Ways to Measure and Improve Home Health Care

Assisting home care providers in using patient outcome data to improve care

From 1988 through 2003, the Robert Wood Johnson Foundation (RWJF) supported the Development and Implementation of a Quality Improvement System for Home Health Care. The effort comprised six projects and was designed to improve the quality of home health, long-term and ambulatory care, and to study methods to improve health care quality in these settings.

Conclusions:

(Center for Health Services Research, Colorado Health Sciences Center)

Staff developed and implemented patient outcome measures-the Outcome and Assessment Information Set (OASIS) and an outcome-based quality improvement (OBQI) system for home health care.

As reported by the researchers in the Journal of the American Geriatrics Society (August 2002):

  • "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 findings "suggest that OBQI had a pervasive effect on outcome improvement for home health patients."

Key Results and Findings:

(University of Maryland, Baltimore, School of Medicine)

  • Researchers developed four sets of clinical practice guidelines on nursing home patients with: new-onset fever, altered mental health status and behavior, significant weight change, and for the terminally ill.
  • Findings as reported in the Journal of the American Geriatrics Society (August 1994) on the guidelines for the terminally ill:
    • "Appropriate medical management of terminally ill nursing home patients should improve their remaining quality of life."
    • "Minimum standards for which 100 percent performance is expected are communication of advance directives, attention to pain control and attention to relief of dyspnea [shortness of breath]."

Key Results:

(Methodist Hospital of Indiana)

  • Researchers designed and implemented an organizational structure to support Total Quality Management.
  • Researchers revised the HealthNet procedure for measuring blood pressure to reflect the latest recommendations and trained staff in this procedure, including initiating annual retraining.
  • Researchers developed a risk model for blood pressure control which identified three measurable factors that influence blood pressure control and could be used in continuous improvement efforts to improve patient outcomes: the degree to which the patient has difficulty in paying for services, the degree to which the patient is overweight, and whether the patient is classified for insurance purposes as self-paying.

Conclusions:

(Indiana University School of Law)

As reported in Medical Care (2003):

  • "Client-centered quality improvement strategies can be implemented to enable community-based long-term care programs to meet client needs better and increase client satisfaction. Current efforts to computerize quality improvement for public community-based long-term care programs should be supported and promoted."

Conclusions:

(State of Vermont Department of Mental Health)

  • Software such as the Vermont Medication Graphics program is most likely to be accepted and widely used if it is integrated into an electronic medical record system. This would provide easy, timely access to data.