Researchers Identify Ways to Measure and Improve Home Health Care

From 1988 through 2003, 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.

Key Findings

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.

  • "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."
  • 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.
  • "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]."
  • "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."
  • 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.