Here's expert advice on creating an OASIS tool
Integration with your assessment form is key
Integrating the Outcome and Assessment Information Set (OASIS) into your existing assessment tool is challenging. Yet, other quality managers have successfully implemented the OASIS data set from the Baltimore-based Health Care Financing Administration (HCFA).
Homecare Quality Management asked five home care quality experts for their advice on how to get started. Here are their suggestions:
1. Collect the latest OASIS data set.
The fastest way to find the OASIS data set is to visit HCFA's Web site at http://www.hcfa.gov; select Medicare; select professional/technical information; select survey and certification; and finally select OASIS. The OASIS data is in an Adobe Acrobat (.pdf) format, which requires the Adobe Acrobat reader software. But HCFA offers a link to a site where this software can be downloaded for free.
Quality managers may obtain additional information about OASIS from two manuals published by the Center for Health Services and Policy Research. (See OASIS resources, p. 136.)
2. Integrate the OASIS data set into your agency's assessment tool.
Affiliated Community Visiting Nurse Association of Rockland, MA, undertook one of the more ambitious OASIS integration projects. The agency was formed after a merger of eight VNAs on July 1, 1997, and the new agency integrated all eight assessment forms into a 25-page nursing tool and similar tools for speech therapy and physical therapy.
The agencies began the integration process well before the merger by forming a team that included representatives from management, performance improvement, clinical experts, researchers, central intake specialists, and others, says Joanne Dalton, PhD, RN, CS, program development manager for the agency, which serves southeastern Massachusetts. "We had the advantage of all of these skilled people from eight agencies," Dalton says.
For about a year, the team met weekly or biweekly to look at various assessment items and select certain ones to include in new tools that also include OASIS data sets. Each team member worked on specific parts of the tool according to their own areas of expertise. For example, wound care experts checked to see if the OASIS data set items were sufficient, or if more questions needed to be added to the tool, Dalton explains.
The tool's questions include two different types:
· A scannable check-box format that includes all of the OASIS data set items and some additional information. These include the information that HCFA eventually will collect, as well as some information the agency can use for quality assurance, program evaluation, and management of information.
· A nonscannable format with questions that leave room for comments that are relevant to admission.
For example, one scannable question might ask if a patient has any problem with skin, hair, or nails. Then there is a follow-up question asking for a comment on where the problem is. "Clinically, we'd want to know where the eczema is on the patient, but for data purposes we only want to know if the patient has eczema or not," Dalton explains.
Nurses will use the more detailed descriptions when they develop care plans for patients, Dalton adds.
Agency's questions listed separate from OASIS
The VNA of Central Connecticut used a slightly different format in the integrated assessment form. The agency's nurses said they preferred to have the agency's own physical assessment questions listed separately from the OASIS questions, says David McKinnon, RN, supervisor of total quality improvement for the Visiting Nurse Association of Central Connecticut Inc. in New Britain.
"In the new tool, we show the physical assessment at the beginning, and then it goes into the OASIS format," McKinnon says. To avoid duplication, McKinnon says, the agency eliminated assessment questions that are repeated in the OASIS data. And although the OASIS tool booklet is 19 pages long, nurses no longer have to fill out some previously used forms, so their workload hasn't been greatly affected, McKinnon says.
Nurses at the Lee (MA) Visiting Nurse Association use a start of care assessment form that completely integrates OASIS data, says Suzanne Hatch, BSN, MEd, CPHQ, quality manager and staff development coordinator for the agency, which serves a county in western Massachusetts. The agency had 42,000 visits in 1997.
"The nurses haven't had any negative feelings about using the new start of care form," Hatch says. "They know they can find the kind of information they need on the tool."
Lee VNA modified its original assessment form to include OASIS data, creating a 16-page start of care assessment. The form is printed on 8.5 by 11-inch 2-part sheets, glued at the top like a legal pad so they can easily be pulled off and put in a three-ring binder. (See sample of Lee VNA's assessment tool, inserted in this issue.)
Lee VNA's form mostly has boxes and spaces for nurses to check. It also includes some fill-in-the-blank items. For example, the first page has a category for allergies, where nurses can write down the items.
Nurses use both forms
The Visiting Nurse Association of Middlesex East and Visiting Nurse Hospice in Stoneham, MA, has been using some OASIS data as part of its involvement with the Prospective Payment Demonstration project, says Jeannette Sheehan, RN, MS, chief operating officer. However, Sheehan says the agency has not integrated OASIS data into its assessment forms. Instead, nurses use both forms, and this adds about 10 minutes to their visits.
Eventually, Sheehan says, the agency will integrate OASIS into its assessment form because this is what HCFA wants.
Agencies could start using the OASIS data even before they integrate it into their assessment forms. This short-cut solution might help agencies meet the Oct. 1 deadline for collecting OASIS data. And quality managers could use the next several months to create the new tool.
3. Put the OASIS tool on computer software.
HCFA suggests agencies put the tool on software so it can be easily downloaded to state Medicare offices after OASIS data collection begins on Jan. 1, 1999. (See HCFA's answers to home care agencies' questions about OASIS, p. 133.) However, many state Medicare offices may not be ready to start collecting OASIS data, so this ambition may be months or even years away from being realized, says Mary St. Pierre, BSN, director of regulatory affairs for the National Association for Home Care in Washington, DC.
Affiliated Community VNA worked with a software development company to create a scannable OASIS form. "It's very costly to buy nurses all hand-held computers. We felt the best way for our agency to collect data for HCFA would be to use scanning technology," Dalton says.
Other agencies will have nurses enter the OASIS data directly into computers, and still others will have data entry clerks type in the information from paper forms.
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