Home Health Agencies

Home Health Outcomes Based Quality Improvement (OBQI)

Frequently Asked Questions

Q. If I sign up for the Outcome Based Quality Improvement (OBQI) project, what will my home health agency receive from the project?

A. This project gives your agency a unique opportunity to see the effects of your patient care and the results of your Outcome and ASsessment Information Set (OASIS) data collection presented in terms of patient outcomes. Your agency is already collecting OASIS data; through this project, you will learn how to interpret and use the results of your data collection efforts to improve patient care at your agency. There is no fee to participate in this project. All services, products and technical assistance by the New Mexico Medical Review Association (NMMRA) will be provided at no cost to you. Your outcome report will enable you to compare your agency's performance with a national reference group for 41 outcomes. Participation enables your agency to work with the OBQI experts, while developing agency policy and procedures prior to national implementation of OBQI.

A. You will agree to send at least two staff members to OBQI training (held in four locations across New Mexico) to be scheduled in March 2003. There is no fee for the workshops. However the cost of travel and lodging for your staff, if necessary, will be your agency's responsibility. NMMRA will work with home health agencies to try to best accommodate times and locations. After OBQI training, your attendees will be expected to train your agency staff in the OBQI processes that will be implemented. When you review your outcome report, you will conduct a process-of-care investigation within one month and write a plan of action for improving patient care in one or two clinical areas. NMMRA will provide technical support. Your plan of action will be submitted to NMMRA for review and feedback. You may submit either a "hard" paper copy directly to NMMRA or via the Internet at http://www.medqic.org. Since OBQI is an ongoing process, not a one-time project, you will be expected to review and monitor your plans of action for progress throughout the year, making updates where necessary with assistance from NMMRA.

A. Although data quality issues are not specifically the purpose of this OBQI project, there are OASIS resources you can use to assess and improve your data quality. Some of these resources in New Mexico are the state OASIS Education Coordinator (OEC)((505-476-9056), the OASIS and Prospective Payment System (PPS) Web sites (http://cms.hhs.gov/oasis and http://cms.hhs.gov/HomeHealthPPS/), and the OASIS Implementation Manual (Chapters 8 and 12). Use these free resources to monitor and increase (if necessary) the accuracy of your OASIS data. These activities will allow you to be confident that the data depicts what is truly occurring with your patients when their assessments are recorded. This will give you a good starting point for your outcome report.

A. We understand that PPS presents financial challenges for the majority of certified home health agencies in the country. Our training gives you the opportunity to learn OBQI, to use your OASIS data, and to assess and improve your agency's quality of patient care. Sending two people for training is highly recommended; doing so would enable your efforts to continue should one person become unavailable, for whatever reason. The potential benefits of implementing OBQI; improving patient care and streamlining the patient care processes at your agency could exceed the short term costs of training two people.

A. The training is designed to include guided experience with the same activities you will need to conduct in your agency after receiving your outcome report. In the OBQI demonstration projects, it was found that the thought process of starting with outcomes and then moving to care process investigation is new to clinicians and requires some time to experience and incorporate. Practice and experience under the supervision of expert training staff will help you when you return to your agency. Sending one person to training, while possible, is not ideal. Having two people trained in the OBQI processes allows them to supplement one another if other agency responsibilities must occupy one individual. This also means that more than one person can be involved in training your other agency staff.

A. The obvious benefit you will receive is the ability to monitor and to improve the quality of care you provide. You will see how your agency compares with a national reference for the 41 outcome measures reported on the OASIS outcome reports. Agencies that have participated in the OBQI demonstrations report that incorporating OBQI into their operations helped streamline many of their processes. Another major benefit occurs when agency staff members review the annual outcome report, and recognize the changes they helped implement have influenced OASIS data.

A. Extra expense to the agency should be minimal if OBQI is incorporated into already existing processes in the organization. An existing Quality Improvement (QI) team could absorb several responsibilities in OBQI (OBQI responsibilities may actually replace other responsibilities). By changing clinicians' care behaviors to have positive impact on a patient's outcomes, the agency operates more efficiently through standardized care planning and provision. The benefit to patients of improved quality of care obviously must be weighed against any cost incurred.

A. It is important for ALL the agency staff to be aware of OBQI and its basic principles. During the pilot studies, demonstration agencies observed that administrative involvement and backing was very important to the attention OBQI received in the organization. A group/team (the size of the team depends upon the size of the agency) is needed in OBQI to investigate the processes of care leading to a specific outcome and to develop and implement the OBQI plan of action. Involvement of staff in the plan of action is critical, but this usually can be incorporated in other activities already in place in the agency (staff meetings, newsletters). If an agency has QI teams in place already, these teams also can be involved in OBQI.

A. OBQI has two stages. The first stage includes the collection of uniform data at uniform time points using a standardized data set (OASIS), followed by data analysis and preparation of agency-level outcome reports. The second stage, outcome enhancement, includes targeting specific outcome measures (in the agency-level report) for improvement or reinforcement. Continued OASIS data collection allows the agency to see whether these targeted outcomes are improved in the next outcome report.

A. The patients represented in your agency-level outcome report are the patients for whom you have transmitted OASIS data to the state of New Mexico. To compute patient outcomes, two data collection time points are necessary. Thus, to be included in the risk-adjusted outcome report, a patient must have a Start of Care (SOC) or Resumption of Care (ROC) assessment and a transfer or discharge assessment. Patients with only one assessment are not included in the outcome report. The risk-adjusted outcome report includes a duplicated patient count, since outcomes are reported for each outcome interval (outcome episode). An outcome interval or outcome episode can vary in length. The outcome episode is not the same as an episode for PPS (60 days).

A. QIO stands for Quality Improvement Organization. Quality Improvement Organizations in every U.S. state and territory work under the direction of the Centers for Medicare & Medicaid Services. The New Mexico Medical Review Association (NMMRA) is the QIO for New Mexico. QIOs provide expertise and leadership in quality improvement. This project provides a unique opportunity for home health agencies to obtain expertise in Outcome Based Quality Improvement (OBQI). NMMRA does not charge agencies to participate in this project or for OBQI consultation services.

A. No. Although NMMRA and the New Mexico Department of Health, Division of Health Improvement, Health Facility Licensure and Certification Bureau are interested in quality of care, NMMRA's role is not regulatory in nature. The state survey agency will continue to monitor compliance with the Conditions of Participation, while NMMRA will act as a resource to facilitate your agency's own quality improvement activities.

A. Implementing OBQI, using reports derived from OASIS data, is new to most agencies. Experience with OBQI demonstration agencies showed that existing quality improvement processes and activities are likely to be very compatible with the outcome enhancement steps of OBQI. This program will assist you to understand and interpret OBQI reports and to integrate your current program with the OBQI process.

A. Yes, this project focuses on continuously improving the effectiveness of patient care, which is a large component of an agency's quality improvement program. This project does this by assisting you in examining the outcomes of care for your patients. Other aspects of quality (e.g., those concerned with agency structure, risk management, and the like) are outside the scope of this project and will require you to develop that aspect of your program using other resources not included in this program.

A. All JCAHO accredited agencies are required to utilize performance measures in their quality improvement programs. These performance measures may be outcome or process measures. The outcome enhancement activities you learn in this project may assist you to respond to your performance measure reports, but the OBQI reports are not intended to substitute for these reports. The May/June 2002 issue of Home Care Bulletin, the JCAHO newsletter reported that JCAHO would create a web-based option to allow Medicare-certified agencies to self-report OASIS quality indicator aggregate data to JCAHO. This option will permit agencies to use the same data to satisfy both federal performance data reporting requirements and JCAHO requirements. (The change was reported as being effective Jan. 1, 2003.)