Improving Quality Of Care At Home
QIOs Training Home Health Agencies Nationwide

Training For Better Care:

Quality Improvement Organizations (QIOs) are playing a central role in a new federal initiative to help home health agencies improve the quality of their care. The agencies deliver skilled nursing care, physical and occupational therapy, patient and caregiver education, and other medical services to patients at home.

Working under contract to the Centers for Medicare and Medicaid Services (CMS) at HHS, QIOs are training agency caregivers to select treatment processes for improvement; to create and implement step-by-step plans designed to improve care; and to integrate continuous quality improvement into ongoing staff training. QIO training— which is voluntary—is offered at no cost to home health agencies. More than three-quarters of all Medicare-certified home health agencies have signed up and received training.

Increasing Public Awareness:

The HHS initiative to improve home health quality combines QIO quality improvement training with a new CMS initiative to publicly report on eleven measures of quality of care provided by every participating Medicare home health agency. For each agency, CMS is reporting to the public on the percentage of patients who have needed emergency care or who had to be admitted to the hospital, as well as the percentage of patients with less pain and confusion. The data presented on the CMS web site also shows how well the agencies helped patients improve in walking, bathing, toileting, and taking medication. QIOs will help the public understand and use these quality measures as part of the process of selecting home health agency services.

Sharing Effective Methods:

QIOs are training home health agencies in a process—known as Outcome-Based Quality Improvement (OBQI)—that involves collection, analysis, and feedback of information on quality of care and patient progress that is of practical value to clinicians. To participate in Medicare, home health agencies are required to collect and submit data to CMS on 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. The data also documents how well each agency is helping patients improve grooming, bathing, dressing, meal preparation, and other daily activities.

OBQI provides home health agencies with methods for interpreting patient data, targeting care processes for improvement, restructuring care, and monitoring how change in care affects patient recovery and quality of life. Studies in a number of states have shown that using OBQI significantly reduces hospitalization of patients. The lead QIO on the home health initiative—Delmarva Foundation of Maryland—has also created and launched a website (www.obqi.org) where home health agencies can share experiences and information.