JCAHO requiring agencies to collect outcomes data
Can systems meet private duty providers’ needs?
The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, recently announced its plan and timetable for integrating outcomes and other performance measures into the accreditation process. Private duty providers, however, worry that systems approved by the organization won’t adequately serve their needs.
The initiative, called ORYX: The Next Evolution in Accreditation, will require health organizations to collect performance data on outcomes of patient care and submit the data to the Joint Commission on a continuing quarterly basis.
ORYX will be supported by 60 measurement systems with which the Joint Commission has contracted. These systems were selected from among 71 reviewed by the Joint Commission last fall. Included in the 60 are 19 systems specifically designed for home care. (For a listing, see p. 41.)
Based on her initial research, one private duty provider says she doesn’t believe any of the 19 systems will work for long-term chronic patients, which is most of her client base.
"If none of the outcomes are applicable for long-term patients, what are you going to do?" asks Judy Earley, RN, president of Emerald Health Care Services, Pompton Lakes, NJ. "It’s not valuable for me to buy a software that covers only [a small percent] of my patient population."
Earley says other private duty agencies that are Joint Commission-accredited might run into the same problem. "Certainly there are a lot more Medicare-certified agencies. No one has been gung-ho on developing this program for private duty agencies, but maybe people just aren’t aware of the problem."
Initially, hospitals and long-term care organizations will participate in ORYX. A parallel group of requirements is being developed for integrated delivery networks, health plans, and provider-sponsored organizations. Shortly thereafter, ORYX will expand to require home care organizations, both hospital-based and freestanding, to submit data along with behavioral health, ambulatory care, and laboratory organizations.
By Dec. 31, 1997, each accredited hospital and long-term care organization must choose a performance measurement system from the contract list. Also by that date, hospitals and long-term care organizations must select at least two clinical performance indicators from their measurement system that relate to 20% of their patient population and inform the Joint Commission of their selections. They will begin submitting data no later than the first quarter of 1999.
Home care agencies will be required to meet the same criteria by Dec. 31, 1998. Hospital-based entities, however, if accredited under the hospital, may choose a measurement system in 1997 if home care represents 20% of the hospital s total patient population. But hospital-based agencies, like their freestanding counterparts, will not be required to select a system until 1998. Home care and the others will collect and send data to the Joint Commission in the year 2000.
Emerald Health Care Services was among the first agencies in its area to become certified by the Joint Commission. Ever since then, Earley says she has searched for data that would be useful in benchmarking.
"We are private pay and Medicaid," she says. "Most of our patients are not the type who are going to get better. They have chronic conditions like Alzheimer’s. What can I measure and how can I find someone to measure against?"
In New Jersey, the home care industry is very divided, Earley says. "You are either Medicare or you are private duty," she explains. "You aren’t both. Our goals and measurements are very different. We can’t measure if a patient gets better, because 90% of the time they don’t. Agencies that are private pay, such as hers, are unwilling to part with what they consider is proprietary information."
Any benchmarking data that Earley has found does not relate to the things that she can measure: rehospitalization, stress levels in families, placement in long-term care facilities, retention of educational material, and improvements in nutrition and personal care.
These are all items which she measures for her own agency’s use. "But without comparison, it is of limited value," she says. "And the other agencies in our area are measuring very different things. National databanks and software are also looking at things that apply to the 10% who will get better, not chronic cases."
On-line and e-mail searches prove futile
Her on-line searches she looks every day, she says and e-mail missives to news groups searching for assistance have drawn blanks. "Every meeting I go to, this is a topic, but no one is doing anything." Earley faces a Joint Commission survey in September and is concerned that her efforts won’t be viewed as either valid or as going far enough.
Not to worry, says Maryanne Popovich, RN, MPH, director of home care accreditation services at Joint Commission. She already has the measures in place, says Popovich. All she needs to do is get on the phone and start some networking in New Jersey. The state association, Home Health Staffing Association, should be able to put her in touch with others who are like her.
If the association is not already gathering data which is of use, Earley and the other agencies in her situation should encourage it to start acting as a clearinghouse for aggregating data so that proprietary information is not an issue.
The problem, though, still remains about finding an approved outcomes measurement system that will work for Emerald’s business. Earley suggests private duty providers that are Joint Commission-accredited should call the organization to express their concerns. She also put a call out to software developers: If someone has good computer common sense, please come up with a program for us that is affordable and is easy to use.
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