A useful tool, but OASIS needs a little refinement
Some home health quality managers who already have been exposed to HCFA’s Outcomes and Assessment Information Set (OASIS) through the Medicare demonstration project find merit in the tool, even though they admit agencies will be burdened at first.
"If they [HCFA] do want to see that home health care makes a difference, outcomes would be important," observes Jeannette Gronda-Kootsillas, RN, BSN, MSA, the clinical director for Henry Ford Home Health Care in Detroit. "I like the concept of OASIS, but they’ve got a long way to go. It does add time. There are 89 questions [sic] and from what I’ve read in the literature, 30 to 45 minutes are added to most visits.
"I don’t see a big change from what we’re doing," adds Gronda-Kootsillas, "but a change in the way things are packaged. We [Henry Ford] are heavily into quality improvement. A lot still has to be done by hand."
Yet, OASIS falls short in some instances by not requiring sufficient data, Gronda-Kootsillas says. "For example, the ostomy section focuses on only the prior 14 days of hospitalization, not the year before. For any changes in the G.I. system, there’s not a place to talk about that.
"And for respiratory, there are only a couple of questions. It doesn’t give you all you need to carry through a plan of care. There are very few things on a medical assessment you could replace these [OASIS] with," she says. "I like the ADL section, however. There are a lot of good questions with it. But you still don’t get a complete picture of what’s going on with the patient."
Another problem with OASIS, other outcomes experts say, is the format for collecting data.
Says Cathy Nielsen, RN, CPHQ, vice president of clinical services for In-Home Health in Minnetonka, MN, "If the conditions of participation require OASIS, it will be a burden. You may have collected data in a different way. If agencies have to use OASIS, that will be changed. It will take time for ramping up, staff education, additional forms, so it will have an impact on Medicare-certified agencies."
Karen Lajoy, PhD, director of training and quality management for Rehab Without Walls /Olsten Health Services in Portland, OR, agrees that OASIS "will be a burden in the start-up. You can’t expect to add something and there not be a learning curve. Unfortunately, there’s going to be a learning curve that will result in administrative costs."
But she says she thinks it will benefit home health agencies in the long run.
Integrating OASIS requires flexibility
"Some of the [OASIS] demonstration sites we worked with say that once they start using OASIS, they see that they were doing some things they don’t need to be doing. OASIS can take their place. It doesn’t take any longer as long as agencies are flexible enough in their thinking to integrate it into their current system.
"Adapting a quality system like this is going to make the whole area of home health more credible. It’s going to allow for home health to really have some outcomes to report, and there’s not going to be any doubt about what we’re doing in home health," says Lajoy.
"Right now, outcomes are anecdotal. But these will be based on solid data, and that’s going to help the industry," she says.