Time to give your OBQI reports more attention

Mandatory use is coming soon

You’ve been evaluating your Outcome Based Quality Monitoring Reports, but why worry about Outcome Based Quality Improvement (OBQI) reports?

Because state surveyors have access to the information, and they may be using it to prepare for their visits as early as January 2003, according to the Centers for Medicare & Medicaid Services (CMS) officials.

"The use of OBQI data to evaluate an agency’s performance is not required at this time. We do, however, anticipate that the Conditions of Partici-pation will be amended to require an agency to use OBQI data to identify areas of improvement in June 2003," explains one CMS official.

Suggested reading

Even if the use of OBQI data is not mandatory until the summer of 2003, agencies need to start looking and using the reports now, advises Merryl M. Gottschalk, RN, director of healthcare consultants for Healthcare ConsultLink in Azel, TX.

"There are a lot of data in the OBQI reports, and it takes time to learn how to read it," she says.

In addition to looking at the reports, it is expected that agencies will have to use the data to choose areas of improvement that need to be addressed once the regulations are finalized, says Gottschalk.

CMS officials agree and say, "An agency would select specific outcomes based on their statistical significance in the report, evaluate the care related to that outcome, and develop plans to improve the care if needed, or reinforce the care if the agency’s outcomes are good in that area."

Surveyors will look to see how those plans are implemented and if subsequent OBQI reports show improvement.

OBQI reports contain risk-adjusted outcome data that show how the care your agency provides compares with the care provided by agencies caring for similar patients.

"The 41 outcomes measured by OBQI will help agencies determine if their patients are getting better and what contributes to this improvement," Gottschalk says.

When you pull your OBQI reports, you’ll notice asterisks placed beside some outcomes. The asterisks indicate the areas with the most potential for improvement. Two asterisks indicate areas in which there is a 5% or less chance that the difference between your score and the national benchmark is pure chance. One asterisk indicates that there is a 5% to 10% chance that your score is due to chance.

"Focus on the areas with two asterisks first," CMS officials suggest.

By focusing on the outcomes that differ significantly from the national benchmarks, you can evaluate which improvement efforts are going to benefit your patients the most, Gottschalk says.

Once you’ve identified these areas, look carefully to see if you differed as a result of the care you provided or if other factors caused the difference, she says.

"We know that agencies in the East keep patients shorter lengths of time than agencies in Texas. Rural agencies may not be able to affect how long they keep patients because they have fewer resources for the patients to use after discharge from home health," Gottschalk explains.

Eventually, data will be sorted regionally, but until then, use the national benchmark as a guide, then look carefully at which outcomes you can improve, she suggests.

For example, you may need to add a wound care specialist to your team if your patients have wounds that don’t improve at the same rate as other agencies, or contract with a respiratory therapist to provide more aggressive care for respiratory patients, Gottschalk suggests.

Although CMS officials report that 75% to 80% of all home health agencies that submit OASIS [Outcome and Assessment Information Set] data have requested their OBQI reports, they do admit that they don’t know how many are truly using the data to develop quality improvement projects.

Procrastination would be a mistake

"Home health managers are overwhelmed these days, so most will wait until the use of OBQI data is mandatory," Gottschalk points out. That would be a mistake, however, because it takes time to review and evaluate the data, and identify a project, she says.

"It is better to start now, so that when it is mandatory, you already have a process in place," she adds.

When you pull your OBQI data for the first time, you automatically receive one year’s worth of data. For subsequent reports, you can specify what length of time you want to data to cover, say CMS officials.

CMS recommends that agencies download reports no more than once per quarter with the ideal time frame being once every six months. This gives the agency time to implement the quality improvement plan and see changes.

Home health managers can download their OBQI reports through the same system in which they submit OASIS data. Once you reach the server through which you submit OASIS data, choose the OBQI/OBQM link. Choose the reports option then choose which reports you want downloaded.

CMS has published manuals on the use of OBQI data. To download the manual, go to www.cms.hhs.gov/oasis and choose OBQI manual.

Even though the initial reports can be daunting, the effort to evaluate them and develop quality improvement projects is exciting, Gottschalk says.

"This is the first time we’ve had comprehensive outcomes data in home health to evaluate our care. And we need to remember that the point of outcomes-based quality improvement is better care for our patients," she says.

[For more information, contact:

Merryl M. Gottschalk, RN, Director of Healthcare Consultants, Healthcare Consultlink, 6585 Sandy Beach Road, Azel, TX 76020. Tele-phone: (888) 258-1894 or (817) 370-9876. E-mail: MERRYL@sbcglobal.net.]