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EMBARGOED
for release until:
2PM EST February 20, 2003
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Contact:
Richard Deutsch
202-261-7573 |
QIOs
Offer Home Health Agencies Fast Track To Better Care
Test
Shows QIO Training Spurs Rapid Patient Improvement
Washington, D.C.—
Quality Improvement Organizations (QIOs) are launching a national initiative to
train all Medicare home health agencies how to use a new and more effective method
for improving care. Organized and funded by the Centers for Medicare and Medicaid
Services (CMS), the initiative complements a CMS move to publicly report on quality
of care provided by individual home health agencies.
CMS will begin
in April to publish data on the quality of home health care in Florida, Massachusetts,
Missouri, New Mexico, Oregon, South Carolina, West Virginia, and Wisconsin. For
each home health agency, CMS will report on the percentage of patients who have
needed emergency care or who had to be admitted to the hospital, as well as the
percentage who have less pain and are confused less often. The data will also
show how well the agencies helped patients improve in walking, bathing, toileting,
and taking medication. In October, CMS will begin reporting this information on
all Medicare home health agencies nationwide.
QIOs are private
organizations that work under contract to CMS to improve the quality of care in
the nation’s hospitals, doctor’s offices, and nursing homes. This year QIOs also
begin sustained work with home health agencies, following extensive testing in
five states of a new program designed to encourage continuous quality improvement.
"Experience
tells us QIOs will help thousands of home health agencies get on the fast track
to providing better care," said David Schulke, executive vice president of
the American Health Quality Association, which represents the national network
of QIOs. Noting that QIO training is voluntary, he said: "Agencies that sign
up to work with their local QIO can learn how to re-evaluate and improve the way
they care for patients. We expect to see significant, measurable improvement in
every state."
Test
Shows Impact of QIO Support Program
In 2001-2002, CMS
funded a multi-state QIO test of an innovative program for improving care with
the cooperation of 400 home health agencies in Maryland, Michigan, New York, Rhode
Island, and Virginia.
The program showed
almost 900 home health agency staff how to interpret a new type of patient care
report and target treatment processes for improvement; how to develop and implement
step-by-step plans of action to improve care; and how to integrate continuous
quality improvement into agency staff training.
The process—known
as Outcome-Based Quality Improvement (OBQI)—depends on collection, analysis, and
feedback of information on quality of care and patient progress that is of practical
value to clinicians.
"We’ve already
seen home health agencies exhibit a tremendous will to learn and improve. We expect
that expanded QIO guidance, combined with public reporting by CMS on agency performance,
will create a powerful force for change," said Schulke. However, he noted
that motivation on the part of home health agency staff and leaders is critical.
"The hardest work is always done by agency staff who must undertake the changes
that lead to better performance."
More than 90 %
of the agencies that signed up for the recent five-state test project completed
the training. Independent monitoring showed that participating agencies improved
targeted measures of patient care and well-being by an average of seven percentage
points in one year. Measures not selected for training showed little or no improvement.
Results achieved by a number of individual agencies were dramatic. For example:
- With assistance
from the Delmarva Foundation, the Maryland QIO, Personal Touch Home Care (MD)
implemented an OBQI program that reduced emergency hospital admissions for patients
with congestive heart failure during 2001 from 50% to 17%. "We shared our initial
data with our staff and they didn’t like some of the outcomes. The staff really
got into wanting to make improvements and their enthusiasm spilled over into a
lot of other things," said Susan Niewenhous, National Quality Director at Personal
Touch.
- With support from
Quality Partners of Rhode Island, the Rhode Island QIO, the Cathleen Naughton Home
Health Agency in Rhode Island used OBQI to establish and monitor patient exercise
programs that doubled the percentage of patients in 2001 who improved ambulation/locomotion
from 12% to 25%. "Quality of care is our number one priority. But to be able to
see it in the data was amazing," said Kristen Benjamin, Director of Nursing.
"If we did not do this program, we wouldn’t have been able to access information
the way we can now. It is a wonderful thing."
- The Visiting Nurse
Association of Staten Island, with assistance from IPRO, the New York QIO, helped
72.9% of patients improve the status of their surgical wounds in 2001, compared
to 66.4% previously. "Our staff became more knowledgeable and their practice
demonstrated that," said Lois Moses, Vice President of Patient Services.
High retention
rates among home health agencies and positive reports from participants make it
likely that results for 2002 will show continued progress, according to staff
at the Delmarva Foundation, the lead QIO for the project. "What surprised
us was how eager the agencies were to work with QIOs," says Delmarva’s Julie
Crocker, director of the project. "We believe the agencies saw a real opportunity
to improve patient care, because this training offers such a well-structured way
to plan and focus on improving treatment."
A
New Process for Improving Quality of Care
Medicare is the
largest single payer for services provided by an estimated 7000 home health agencies
around the country. In 2000, Medicare covered services for 2.5 million beneficiaries
at a cost of $8.7 billion.
To participate
in Medicare, home health agencies have been required since 1999 to collect and
submit data to CMS on care provided to each patient using a system known as the
Outcome and Assessment Information Set (OASIS). Developed by researchers at the
University of Colorado Health Sciences Center with funding from CMS, OASIS is
risk-adjusted to account for differences in patients, so that performance of agencies
can be reliably compared.
OASIS provides
home health agencies with a basis for identifying and implementing quality improvement
activities. OASIS data shows whether home care has helped patients improve in
a range of critical areas such as cognitive functioning, speech, mobility, and
dealing with anxiety and pain. OASIS also documents how well each agency is helping
patients improve grooming, bathing, dressing, meal preparation, and other daily
activities.
Although home health
agencies operate in a competitive environment, progress towards improving care
has been slow. CMS is expected to require every Medicare participating home health
agency to develop a continuous quality improvement program using OASIS data. To
help home care agencies accomplish this, QIOs will begin offering assistance this
year so that every Medicare home health agency across the nation can successfully
implement the Outcome Based Quality Improvement approach.
A recent three-year
test of OBQI involving 54 home health agencies in 27 states resulted in a 7.2
percentage point decline (from 32.5% to 25.3%) in the annual hospitalization rate
for patients served by those agencies. A separate four-year OBQI project in New
York state led to a 7.9 percentage point decline (from 30.1% to 22.9 %) in the
annual hospitalization rate for patients served by more than 50 agencies.
These projects
also showed significant improvement (between 5 and 7 percentage points) in other
target measures such as improvement in ambulation, dressing, status of surgical
wounds, and urinary tract infection—compared to improvement rates of just 1% in
homes not part of the project.
FOR
MORE INFORMATION: www.ahqa.org
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