Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115462

Karen E. Johnson, MS and Karen B. Pace, PhD, RN. Delmarva Foundation for Medical Care, 7240 Parkway Drive, Suite 400, Hanover, MD 21076, 410-712-7407, kjohnson@dfmc.org

Background: The national rollout of the Centers for Medicare and Medicaid Services' Outcome-Based Quality Improvement (OBQI) initiative began in August 2002. As part of this program, home health agencies (HHAs) voluntarily work with their states' Quality Improvement Organizations (QIOs) to implement the OBQI process. The OBQI process entails collecting and interpreting patient outcome data, selecting from among 41 outcomes for QI efforts, conducting a process-of-care investigation, identifying problems and appropriate best practices, and developing, implementing, and monitoring a plan of action (POA), all with the goal of improving patient outcomes.

Objective: To determine if there was a difference in outcome performance among HHAs that participated in the OBQI process compared to those that did not.

Methods: Data for each outcome were analyzed separately. The 12-month baseline period and re-measurement periods were May 2001-April 2002 and November 2003-October 2004, respectively. For each outcome, the agency-level average at baseline and re-measurement was computed and the change in rates from baseline to re-measurement between participating and non-participating HHAs was compared. Only agencies with data at both baseline and re-measurement were included.

Results: A total of 5,804 POAs were submitted by 4,418 HHAs nationwide. The most frequently targeted outcomes were Improvement in Pain Interfering with Activity; Any Emergent Care; Improvement in Dyspnea; Improvement in Management of Oral Medications; and Acute Care Hospitalization. For these 5 outcomes, the average rates among the participating agencies were inferior to the national average rates at baseline. Participating agencies had statistically significantly larger differences in the amount of change between baseline and re-measurement than did non-participating agencies. For the two utilization measures (Acute Care Hospitalization and Any Emergent Care), although participating agencies as a whole improved significantly more than non-participating agencies, their rates were still inferior to the national average. Finally, although the decrease in Acute Care Hospitalization rates was slight among agencies that targeted this outcome for QI efforts, the rates actually increased among non-participating agencies.

Discussion: These analyses showed that HHAs that participated in OBQI appropriately selected outcomes for QI efforts; that participating HHAs are improving; and that this improvement is typically substantially higher than that of non-participating agencies. The results also show that Acute Care Hospitalization is one of the most difficult outcomes for agencies to improve. Finally, these results are still preliminary: final data for the first cycle of the OBQI program will be available in mid-April 2005.

Learning Objectives:

• Describe the steps in the Outcome-Based Quality Improvement Process
• Discuss the differences between process measures and outcome measures
• Evaluate the success of the OBQI process in the home health setting

Keywords: Home Care, Outcomes Research

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.