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Home Health Quality Initiative

Home Health Quality Initiative. Version 2.0 June 2003. Objectives. Explain purpose and goals of the Home Health Quality Initiative Identify the publicly reported quality measures Interpret and understand the publicly reported data Describe differences from OBQI report

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Home Health Quality Initiative

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  1. Home Health Quality Initiative Version 2.0 June 2003

  2. Objectives • Explain purpose and goals of the Home Health Quality Initiative • Identify the publicly reported quality measures • Interpret and understand the publicly reported data • Describe differences from OBQI report • Discuss how publicly reported measures and OBQI relate • Explain the QIO role

  3. What is the Health & Human Services (HHS) Quality Initiative? • Commitment to quality health care • Accountability and public disclosure • Empower consumers • Stimulate improved quality of health care

  4. Home Health Quality Initiative Timeline • Feb 20, 2003 - HHS Secretary’s formal announcement of HHQI • May 1, 2003 - Phase I • 8 states: FL, MA, MO, NM, OR, SC, WV, WI • Fall 2003 – National Rollout • Early 2004 - Ongoing efforts of CMS/NQF to refine quality measures

  5. Home Health Quality InitiativeFour-Prong Approach • Regulation and enforcement • Improved consumer information • Ongoing QI programs • Collaboration and partnerships

  6. HHQI Components:Regulation & Enforcement • Survey activities remain unchanged • OASIS technical support will continue • QIOs are not part of regulation and enforcement mechanisms

  7. HHQI Components:Community-Based Quality Improvement • OBQI System • QIOs currently assisting home health agencies nationwide

  8. HHQI Components:Collaboration and Partnerships • To leverage knowledge and resources • Collaboration is key to success • Goal to improve communication among all stakeholders

  9. HHQI Components:Consumer Information • Publicly report home health quality measures • Consumers can make more informed decisions about home health care • Stimulate providers to improve care

  10. Home HealthQuality Measures • Eleven measures selected • Subset of the 41 OASIS-derived outcomes • Consumer-friendly presentation of information

  11. How Were the Quality Measures Selected ? • Recommendations from AHRQ • Internal CMS discussion and decisions • Piloted during Phase I

  12. How Will the Quality Measures Be Promoted • Home Health Compare at • www.medicare.gov • Newspaper ads in major cities • Media events • QIO activities

  13. 11 Publicly Reported MeasuresConsumer Language • Patients who get better at getting dressed • Patients who get better at bathing • Patients who stay the same (don’t get worse) at bathing • Patients who get better getting to and from the toilet • Patients who get better at walking or moving around

  14. 11 Publicly Reported MeasuresConsumer Language, cont’d. • Patients who get better at getting in and out of bed • Patients who get better at taking their medicines correctly (by mouth) • Patients who are confused less often • Patients who have less pain when moving around

  15. 11 Publicly Reported MeasuresConsumer Language, cont’d. • Patients who had to be admitted to the hospital • Patients who need urgent, unplanned medical care

  16. Interpreting the Publicly Reported Outcome Data

  17. OBQI 3-Bar Report

  18. Example: Public Report Home Health Compare at http://www.medicare.gov

  19. Outcome Rates • OASIS data from SOC/ROC AND discharge/transfer during the specified 12-month time period • Numerator – all episodes that had the outcome (e.g., improvement, hospitalization) • Denominator – all eligible episodes

  20. What’s the Same? • Outcome rates are computed the same way • Inclusion criteria • Numerator • Denominator • Based on 12 months of data • There is an agency value for the current time period • National reference value – next phase • Phase I reference value for the 8 states only • The same risk adjustment models are used • Except for pain interfering with activity

  21. What’s Different? • Outcomes are called quality measures • The agency value IS risk-adjusted • The national reference is NOT risk-adjusted • Phase I: 8-state aggregate instead of a national reference – risk-adjusted

  22. What’s Different, continued • A risk-adjusted state rate is included • No information on prior time period • Tests of statistical significance are not reported

  23. Risk Adjustment • Statistically accounts for differences in one agency’s patients vs. the reference sample • Minimizes the possibility that differences in outcomes are due to differences in patient characteristics • Separate risk models estimated for each outcome using a national reference sample

  24. Risk Adjustment • All 11 measures will be risk-adjusted • New risk models for: • Any emergent care provided • Improvement in pain interfering with activity • http://cms.hhs.gov/quality/hhqi/

  25. Agency Risk-Adjusted Rate • Current agency observed rate + a risk-adjustment factor • Will not be reported for agencies certified less than 6 months as of end of reporting period • Will not be reported for less than 20 episodes • If value less than 5% reported as “< 5%” • If value greater than 95% reported as “> 95%”

  26. National Reference • Phase I:Current observed rate for the 8 states +a risk-adjustment factor • Weighted average • Observed rate for the national population

  27. Risk-Adjusted State Rate • Current observed rate for the state + a risk-adjustment factor

  28. Example: OBQI Report Agency – National Reference (64.4 – 58.2) = 6.2

  29. Example: Public Report Agency - National 67.49 – 61.29 = 6.2 67 - 61= 6

  30. Conversion from OBQI to Public Report www.cms.hhs.gov/quality/hhqi & www.obqi.org

  31. Role of the QIOs in HH Quality Initiative • Partner/collaborate with stakeholders to promote continuous quality improvement (OBQI) • Provide resources related to the Quality Measures • Create public awareness and use of quality information • Collect lessons learned • Evaluate Phase I efforts • Assist in the national rollout

  32. QIO Activities • Offer OBQI training • Provide OBQI materials and resources • Enlist agency participation in the OBQI System • Provide ongoing consultation and technical support

  33. QIO Activities, cont’d • Publicly reported measures receiving priority for additional resources provided by the QIOs • Quality Measures Resource Binder • Sharing experiences, successes, lessons learned among QIOs and among home health agencies • Materials and information posted to www.obqi.org

  34. How Do OBQI and Public Reporting Relate? • Use the OBQI methodology to implement continuous quality improvement • Continue to use OBQI criteria to target outcomes for improvement • Goal is improved patient outcomes • Monitor progress over time • Publicly reported agency comparisons provide context

  35. How Can Your Agency Prepare for Public Reporting? • Participate in OBQI System with your state QIO • Learn and implement the OBQI methodology • Do your homework on the 11 publicly reported outcomes • Preview data prior to initial publication • Report any data anomalies to QIO

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