Revamped Joint Commission accreditation process on the way
Customized and unannounced surveys the likely result of ORYX
Everyone talks about outcomes, but not everyone has started collecting data to measure patient outcomes. The buzzword will soon become hard fact for many home infusion agencies, thanks to the Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO) announcement that it will require home care agencies to collect and submit performance measurement data quarterly to the Joint Commission, likely to begin in 2000. But data collection could be the least of your worries.
JCAHO has every intention of using the data to keep a watchful eye on your agency. In fact, you may find yourself facing an unannounced survey or having to explain how you’re going to rectify a sudden negative trend in your most recent quarterly performance measurement data. At the very least, the Joint Commission will use your data to cater its survey to your agency’s very own strengths and weaknesses.
The initiative, called ORYX: The Next Evolution in Accreditation, currently proposes that home care providers select a performance measurement system from a list of JCAHO-approved vendors by Dec. 31, 1998.
Oryx likely will force many agencies to move somewhat quickly into collecting data. But that’s not necessarily bad, says Bipin Jethva, RPh, president and pharmacist of Premier Infusion Care in Torrance, CA.
"We’re not doing it now," he says of collecting outcomes data, "but we’ll have to, and it’s probably for the better. We’ll be in compliance with JCAHO, and it will promote industry-wide standards, along with a data tool that would help us market to MCOs and improve outcomes."
You’ll also be required to choose at least two clinical performance indicators from the measurement system that relate to a minimum of 20% of your patient population. Hospitals and long-term care organizations face deadlines one year earlier than those set for home care agencies.
Possible delays
Not everything is going to be rushed through. In fact, the deadlines initially set for home care agencies aren’t set in stone just yet. JCAHO is doing a field readiness survey to decide if it should delay starting the project.
"We’re in the process of doing a field readiness survey," notes Jerod M. Loeb, chief scientific officer for JCAHO. "If it turns out the field readiness survey suggests that it would be better to delay that start time, we may well delay that start time."
But once the process starts, you may find yourself fondly recalling the days when your triennial JCAHO survey was the single step to gaining accreditation. The Joint Commission has no plans to let your quarterly performance measurement data collect dust in between surveys. (For more information on JCAHO system selection process, see story, p. 59.)
"We’ll look at the data on a quarterly basis as the data are transmitted to us and in a consultative way work with organizations transmitting data to us in the period between when surveyors are on site," notes Loeb. "If an indicator rate suddenly moves in a direction we believe suggests there might be an underlying system or process problem within the context of the organization, we might do one of several things":
1. Heed the call.
You may receive a call from the Joint Commission notifying you that they’ve spotted an unfavorable trend and recommending you look "underneath the data" to identify the reason for the problem and a possible resolution.
2. Collect your homework.
A telephone call may not be all. Loeb notes that JCAHO may require you to provide a written report on how the agency is addressing the problems uncovered by the data.
3. The last straw.
In an extreme situation, "If the data would suggest that the particular trend is so problematic that it is within the realm of reason, we might do a survey in an unannounced fashion," says Loeb.
Still need the 3-year survey
He points out that the above monitoring of data is in addition to the three-year survey. Keeping in continual contact with accredited agencies is the primary purpose of ORYX.
"That’s the idea of this being continual as opposed to this being a snapshot every three years," says Loeb. "But the survey process will remain standards based; there is no doubt about that."
However, the data you’ve submitted to JCAHO will tell your surveyor what areas he or she should concentrate on during your agency’s survey.
"We believe the data would be very important in helping to mold and shape the survey so that it is data driven," says Loeb, adding that surveys will be customized to each particular agency based on submitted data.
The expectations of agencies are simple, says Loeb. The Joint Commission will expect agencies to collect data not only in high-volume but also high-cost or problematic areas. You’ll then have to put the data to good use improving the care being provided to patients. It’s this use of data that surveyors will be looking for, in addition to evaluating problems highlighted by reported data.
There is no intent at this time for JCAHO to use the data for any other purpose, says Loeb.
One agency that has been collecting such data for several years is Fairlane Home Infusion, part of the Henry Ford Health System in Detroit. Julie Greening, CRNI, MSA, the Division Director of Fairlane Home Infusion, says getting the data collection system started was the most difficult and time-consuming task.
"If you depend on the computer for outcome information, then all the information has to be in the computer and in there correctly, which is very hard," she says. "There are a lot of people who are not accustomed to putting every single detail into every field in your computer system." As a result, staff education may well be the most critical detail in implementing a successful data collection system.
For example, one outcome monitor Fairlane uses is for catheter infection rates. This requires collecting specific information to enter into the system for every patient infection, including:
• type of catheter (listing the brand and the type);
• type of infection;
• result of infection. (Did the infection result in hospitalization, follow-up treatment, etc.?)
Once your system is up and running and staff have received adequate training on its use, the rest is easy, says Greening.
Joe Cabaleiro, RPh, president of Excel Consulting in Cary, NC, says you don’t have to wait for the JCAHO-appointed deadline to begin collecting data. There are several other ways you can put such information to use.
Save money by collecting data
In addition to managed care contracts, which frequently request patient outcomes information, collecting data can help you save money.
"I would want some outcomes data to be able to figure out if the decisions I’m making in patient care are cost-effective," Cabaleiro says. "If I use this particular piece of equipment, does that limit my number of visits? That’s how I would use the information."
But he notes that collecting the wrong information can be next to useless.
"If I see that 30% of my patients are hospitalized, who cares?" he asks. "That’s a nice little statistic, but it really doesn’t tell you anything." Cabaleiro notes that better data would go one step further and break down the 30% further into why certain patients were hospitalized. Are hospitalizations due to poor care on your part, or are the patients you take so sick that hospitalization is likely?
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