OASIS implementation: One year later, what’s the story?

As OASIS B awaits approval, one agency says pilot was worth the effort

A year after its introduction, the Outcome and Assessment Information Set (OASIS) results are set for release by the the Health Care Financing Administration (HCFA) and the Center for Health Policy Research, both in Denver. The 50 participating home care agencies are expecting their initial data sets by the beginning of February, says Angela Richard, MS, RN, a research associate with the Center for Health Policy Research, and some of the results have already been mailed out.

But other agencies hoping to glean information from the first results of the assessment tool pilot project may have to wait, Richard says. There are no plans yet to release even aggregate data to the general public. "It is being discussed," she says. "We know that it is important to the other agencies, and there is no reason why we won’t release the information. But right now, we are going to concentrate on getting the data out internally."

Also due in early February is OASIS B. Currently, the 50 demonstration agencies have the next version, which has some minor changes in language. They start collecting data using the new version as of Feb. 1. "We expect HCFA to approve the final version by the end of February," she says. After that, the National Association of Home Care will release OASIS to its 4,000 members.

When Advocate Home Health Services in Oak Brook, IL, was chosen as one of the 50 pilot agencies, only one of the agency’s 11 offices adopted the 90-item assessment tool. (See Homecare Quality Management, June 1996, p. 61.)

Lori Spoo, RN, supervisor for quality improvement at Advocate, wasn’t sure whether the complexity of OASIS would allow all 11 offices to adopt the program after the first-year trial. Now she says the success of the pilot is likely to spur the agency to implement OASIS throughout the organization.

OASIS removes guesswork

The success of OASIS is hard to quantify right now, Spoo says, and will remain so until she sees the results. "We think it will help us to see where we need to improve quality throughout the system," she explains. "Before, we had to guess where there might be a problem and focus on that area. Now, this focuses attention on everything."

Part of the problem in measuring success is that the OASIS data cycle is a year long. "It’s not like you can look at monthly data," she says. "That is a weakness, but I understand that if you want to reflect reality, waiting a year is the better option."

She is working on a program that will allow for manual collection and tabulation of data related to Advocate alone, which could help to monitor performance more regularly.

Once she has the information, Spoo will analyze the data to look for trends. "Then we have three weeks to put an action plan together. If that goes according to plan, we may decide we can handle the process for the whole organization this year."

Nurses in other Advocate offices already are collecting OASIS data on some patients. But implementing the program for 11 offices with more than 350,000 annual visits is a daunting task. "There will be an expansion of OASIS in our organization during 1997, but we just don’t know how deep that expansion will go," she says.

The experience of the first office in implementing OASIS will serve as an important lesson to the other 10, says Spoo. "It will be easier for the next group because there are more people trained in OASIS than there were when we started."

Initially, just two nurses were trained for the project. They did a mini-pilot that lasted three weeks. Advocate then convened a focus group to discuss what changes should be made and how to implement OASIS in one of the offices. Among the suggested alterations were the sequencing of some items. "Some of them wanted the original nursing notes as the last page, and there were discussions on where to put the vital signs. These things mean little to me, but a lot to them."

The rest of the nurses were then trained and the project begun in earnest. "Now, all of those nurses and their experience with OASIS can help us to do a better job with it in our other branches," she says.

The OASIS tool itself has since been updated to its B version, Spoo says. "It looks like [they have] taken some of our suggestions to heart." For example, one question in OASIS A asked if the patient has life expectancy of less than six months. "It’s not always obvious on admission if that is true. Our suggestion was to add ‘unknown’ as a choice. Another prognosis item also needed that as a choice, and it was added."

Also easing the way for Advocate’s company-wide implementation will be lessons learned by the staff during the trial, Spoo says. She cites three in particular.

1. Nurses learned to save time.

The original assessment form at Advocate was just a single page and took 45 minutes. The 27-page OASIS form initially took nurses 90 minutes to complete, Spoo recalls. But nurses quickly realized that many of the questions could be answered through observation. "We don’t have to ask every question of the patient," she says.

Time also was saved because other forms the nurses had to fill out were made obsolete by the new OASIS assessment. "Now, the only other form in the admission folder is the patient consent form," Spoo says. The whole admission currently takes an hour.

At a meeting of the 50 pilot agencies, Spoo says they reported no overall increase in the amount of time it takes to admit a patient. "We talked a lot about our experiences in implementing OASIS and getting over the learning curve," she says. "Most of what everyone else said was in line with our experience.

2. Management worked hard to get the nurses on board.

There was a realization from the beginning that nurses might balk at the "extra work" involved in the project, Spoo says. Her supervisor gained acceptance among the nursing staff by telling them that OASIS "was a way to document the things they had always done. If they aren’t documenting it, then they are selling themselves short and denying an opportunity to show their managers all that they do."

3. Management was willing to part with money to make the project work.

During the initial three-week pilot, and during the training period for the rest of the office, the caseload for the nurses was decreased, allowing them to learn the processes involved. "We had to bring in a lot of relief help at first," Spoo says. Without that kind of support, Spoo says the project would have faltered.

Benefits still accruing

While the measurable benefits are still pending, Spoo says there are things she can point to that have improved because of OASIS. "Morale certainly increased because there is a feeling that we were considered good enough to get into the OASIS trials." There also is pride in the thought that Advocate and its staff have a chance to influence health policy. "That was really demonstrated when they gave us OASIS B and we saw they had taken our suggestions on it," she says.

The changes in OASIS B are mostly important to the field workers, Spoo says. "The same information is being collected, but there are a few extra choices, and some questions are less wordy."

[Editor’s note: Quality managers wanting more information on OASIS can call the Center for Health Policy Research in Denver at (303) 756-8350.]