Process measures require use of assessment tools
Agencies must address all outcome areas
The biggest challenge that home health managers will face with the proposed OASIS C is the addition of 30 process measures that will affect outcomes.
Even with the additional preparation and training that the process measures will require, they are a good thing for home health, says Judy Adams, RN, BSN, HCS-D, COS-C, a Chapel Hill, NC-based home health consultant. "The process measures follow the Centers for Medicare & Medicaid Services' (CMS) focus on patient outcomes and implementation of best practices," she explains. Many agencies already may use standardized tools to identify the need for additional intervention for certain risks or conditions, but there are also many that will have to incorporate the use of assessment tools, she says.
The process measures focus primarily on five areas, says Adams;
pressure ulcers;
foot care for diabetics;
depression;
falls prevention;
heart failure.
With each area, home health nurses are expected to use standardized tools to identify risk factors, recognize symptoms, and incorporate best practices for the prevention and treatment of these conditions, says Adams. "Almost all home health agencies have tools to assess the risk of falls, and tools for the other areas already exist," she says.
The addition of the process measures does mean that home health agencies that have focused only on one or two areas of Home Health Compare outcomes will need to broaden their scope, says Adams. "This will be a challenge for some small agencies," she admits.
"You do have the option of saying that you have not used an assessment tool," points out Rhonda M. Will, RN, BS, COS-C, HCS-D, senior clinical consultant for Fazzi Associates in Northampton, MA. One of the questions related to depression asks the nurse if a screening tool was used to assess risk of depression. "You can choose to answer no; yes; and yes, the patient exhibits symptoms of depression," she says. "Even though you can answer "no," the question is there for a reason, which means that CMS wants us screening patients for the risk of depression," she adds. Screening tools don't have to be complicated, she points out. "As long as the tool is scientifically based and developed by a reputable source, it will work," she says. "In fact, there is a two-question screening tool for depression that works well," she adds.
Even though the process measures will create a challenge for some agencies, CMS did select measures that were within the control of the agency, points out Will. "We can't control re-hospitalization, because ultimately a physician makes that decision, but we can control how early we identify a potential problem and intervene to prevent the problem such as a fall or treat depression earlier rather than later. The process measures will help improve the care we provide."
Resources
The Patient Health Questionnaire-2 is a simple, two-question screening tool for depression. Go to http://www.cqaimh.org/pdf/tool_phq2.pdf to download an explanation of the tool and questionnaire.
A wide range of assessment tools for home health can be accessed at www.qualitynet.org. Select the "MedQIC" button at the top of the page, and then choose "home health" for a listing of tools and reference material.
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