Measurement and Evaluation
Agencies will evaluate many aspects of care – including pain management, patient experience, functional status improvements and safety gaps as part of overall Home Health Quality Reporting Program. Agencies should consider monthly review of quality data and review of clinician-specific measures. Agencies with multiple branches should assess performance of each branch. These process and outcome measures can also be part of a Total Quality Assessment and Performance Improvement (QAPI) program.
Measures for Value-Based Purchasing
Value-based purchasing is becoming more prominent in home health. See
VNAA's VBP e-Toolkit for information on how payers are linking reimbursement to outcomes and how agencies can prepare for the transformation. Home health outcomes will be carefully monitored by payers participating in the
CMS Comprehensive Care for Joint Replacement pilot tests. Agencies should work closely with conveners (hospitals and groups) receiving bundled payments to ensure that measures and quality improvement activities align with goals of the value based purchasing initiative.
As Home Health is increasingly evaluated through
Home Health Star Ratings, it is also imperative that agencies review all
Home Health Compare and Star Rating measures for patients in the Hip and Knee Joint Replacement Program.
Best practice tip: Generate measurement reports weekly or at minimum, monthly to be reviewed by team members, including clinicians. Develop criteria for improvement directly related to Home Health Compare and Star Ratings.
Standard Measures Relevant to Joint Care Outcomes
OASIS Outcome and Process measures:
- Frequency of pain interfering with activity or movement
- Improvement in Ambulation
- Improvement in Bed Transferring
- Improvement in Bathing
- Surgical wound improvement
Claims and Survey Measures:
Incidence of major falls
Emergency care needed (with or without hospital admission)
Unplanned re-hospitalizations
Provides care in a professional way (HHCAHPS)
How well did the team communicate with patients (HHCAHPS)
Did your team discuss medications, pain and home safety with you (HHCAHPS)
Would you recommend the agency to friends and family (HHCAHPS)
Other Non-Standard Measures
Self-Care and Functional Status
Patient/caregiver are able to verbalize how and when to contact the agency after hours.
Patient/caregiver can demonstrate/verbalize understanding of pain management.
Patient demonstrates ability to take medications correctly.
Patient able to verbalize medication actions/side effects to report/administration schedule
Patient/caregiver can verbalize home safety precautions.
Patient demonstrates progress towards goals.
Patient/caregiver able to demonstrate self-care
Physical Therapy Measures
Other Outcome Measures
The NIH PROMIS tool is increasingly used to assess patient–reported health status and outcomes for physical, mental, and social well–being. CMS may test or adopt it as some future point. PROMIS instruments measure concepts such as pain, fatigue, physical function, depression, anxiety and social function.
VNANE Best Practice Tip: Tactics to enhance home care customer experience / satisfaction measures:
Staff education and training about patient experience, reports and influencers of satisfaction with recognition that there is a low margin of error for home care
Telephone calls to each new patient 24 hours before start of care
Telephone check in with patient within the first 2 weeks of care, to ensure satisfaction with quality of care
Agency-specific calendar posted on the refrigerator on which the case manager writes the visit schedule for each discipline.
Telephone call before visiting
Weekly/monthly measurement reports: team/clinician measures reviewed with supervisors “critical for improvement”
Spotlighting of positive stories for staff
Based on Press Ganey’s “The Banner Story: Improving Home Care Patient Satisfaction to Stay Ahead in a Competitive Market”