Using OASIS data collected by all Medicare-certified home health agencies, this article first presents descriptive statistics on patient outcomes for a national agency sample in 2001, soon after Medicare prospective payment implementation. Ratios of actual to predicted outcome rates, aggregated for groups of outcomes, are considered as potential summary indicators of agency outcome performance. The aggregate ratios show promise, but information on each outcome remains critical to agencies' outcome improvement efforts. Ratios for some outcomes are interrelated, suggesting that agencies focusing outcome enhancement efforts on a few target outcomes also may improve related outcomes.
"Because it is unclear which of the five ADLs is most appropriate, it is not desirable to use an individual ADL outcome [10,11]. However, incremental changes in ADLs are evaluated to determine if any specific ADL is a major contributor for declines experienced in the indices. "
[Show abstract][Hide abstract] ABSTRACT: Research that examines the quality of home health care is complex because no gold standard exists for measuring adverse outcomes, and because the patient and clinician populations are highly heterogeneous. The objectives in this study are to develop models to predict functional decline for three indices of functional status as measures of adverse events in home health care and determine which index is most appropriate for risk-adjusting for future quality research.
Data come from the Outcomes and Assessment Information Set (OASIS) from a large urban home health care agency and other agency data. Prognostic data yields 49,437 episodes, while follow-up data yields 47,684 episodes. We tested three indices defined as substantial decline in three or more (gt3_ADLs), two or more (gt2_ADLs), and one or more (gt1_ADLs) ADLs. Multivariate logistic regression determines the performance of the models for each index as measured by the c-statistic and Hosmer-Lemeshow chi square (chi2).
Frequencies for gt3_ADLs, gt2_ADLs, and gt1_ADLs are 212 (0.43%), 783 (1.58%), and 4,271 (8.64%) respectively. Follow-up results are comparable with frequencies of 218 (0.46%), 763 (1.60%), and 3,949 (8.28%) for each index. Gt3_ADLs does not produce valid models. The model for gt2_ADLs consistently yields a higher c-statistic compared to gt1_ADLs (0.754 vs. 0.679, respectively). Both indices' models yield non-significant Hosmer-Lemeshow chi square indicating reasonable model fit. Findings for gt2_ADLs and gt1_ADLs are consistent over time as indicated by follow-up data results.
Gt2_ADLs yields the best models as indicated by a high c-statistic and a non-significant Hosmer-Lemeshow chi2, both of which exhibit exceptional consistency. We conclude that gt2_ADLs may be preferable in defining ADL adverse events in the context of home health care.
BMC Health Services Research 02/2006; 6:162. DOI:10.1186/1472-6963-6-162 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Home care service organizations need a means of gaining useful feedback about satisfaction with care from clients and their families. Interviews were conducted with 82 older adult clients and 52 family members about their satisfaction with home care. A subgroup of participants (n = 39) provided "contingent" satisfaction responses. Contingent responses reflect the duality of perceptions that clients and families convey about services. Three themes emerged as critical to understanding these types of responses: adept versus inept staff, predictable versus precarious scheduling, and responsive versus restrictive care plans. Understanding the reasons for contingent responses could help home care agencies to target quality improvement initiatives for individual clients and families.
Home Health Care Services Quarterly 10/2011; 30(4):161-77. DOI:10.1080/01621424.2011.622242
[Show abstract][Hide abstract] ABSTRACT: Racial/ethnic disparities in health have been well-documented. However, we know little about the existence of or mechanisms that contribute to disparities in home health care. This article proposes a conceptual framework, based on a comprehensive review of the literature, to guide research to understand whether and how disparities emerge in home health care. The framework outlines the patient, agency, practice, and system factors that have been shown to or theoretically could contribute to disparities. Enhanced parity in home health care will impact society by reducing health costs due to morbidity, while directly benefiting minority patients.
Home Health Care Services Quarterly 01/2012; 31(1):1-40. DOI:10.1080/01621424.2011.641919
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