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  • Measure Summary
  • NQMC:007604
  • Mar 2016
  • NQF-Endorsed Measure

Home health care: percentage of home health episodes of care during which the patient improved in ability to walk or move around in a wheelchair.

Crisler KS, Hittle DF, Conway KS, West LR, Shaughnessy PW, Richard AA, Powell MC, Lawlor KL, Donelan-McCall NS, Beaudry JM, Baillie LL, Schlenker RE, Engle K. OASIS and outcome-based quality improvement in home health care: research and demonstration findings, policy implications, and considerations for future change. Vol. 3, Research and clinical supporting documents [9 supporting documents]. Denver (CO): Center for Health Services Research, University of Colorado Health Sciences Center; 2002 Feb 1.
Hittle DF, Crisler KS, Beaudry JM, Conway KS, Shaughnessy PW, West LR, Richard AA. OASIS and outcome-based quality improvement in home health care: research and demonstration findings, policy implications, and considerations for future change. Vol. 4, OASIS chronicle and recommendations. Denver (CO): Center for Health Services Research, University of Colorado Health Sciences Center; 2002 Feb 1.
Home Health Quality Measures – Outcomes. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2016 Mar. 10 p.
Shaughnessy PW, Crisler KS, Hittle DF, Schlenker RE, Conway KS, West LR, Powell MC, Richard AA. OASIS and outcome-based quality improvement in home health care: research and demonstration findings, policy implications, and considerations for future change. Vol. 1, Policy and program overview. Denver (CO): Center for Health Services Research, University of Colorado Health Sciences Center; 2002 Feb 1.
Shaughnessy PW, Hittle DF, Crisler KS, Powell MC, Richard AA, Kramer AM, Schlenker RE, Steiner JF, Donelan-McCall NS, Beaudry JM, Engle K, Conway KS, West LR. OASIS and outcome-based quality improvement in home health care: research and demonstration findings, policy implications, and considerations for future change. Vol. 2, Research and technical overview. Denver (CO): Center for Health Services Research, University of Colorado Health Sciences Center; 2002 Feb 1.

View the original measure documentation External Web Site Policy

Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of home health episodes of care during which the patient improved in ability to walk or move around in a wheelchair.

Rationale

Patients need certain physical abilities and capacities (motor skills, symptom relief) to walk or move around in a wheelchair. Many patients who receive home health care are recovering from an injury or illness and may have difficulty walking or moving around safely. They may need help from a person or special equipment (like a walker or cane) to accomplish this activity. The required physical abilities for walking or moving around in a wheelchair can be developed or maintained by managing patient symptoms or through rehabilitative services. Home health care staff can encourage patients to be as independent as possible and can evaluate patients' needs for, and teach them how to use, special devices or equipment to help increase their ability to perform some activities without the assistance of another person. Maintaining and improving functional status, i.e., patients' ability to perform ambulation/locomotion, contributes to quality of life and allows them to live as long as possible in their own environment. Getting better at walking or moving around may be a sign that they are meeting the goals of their care plan or that their health status is improving. Recovering independence in walking or moving around in a wheelchair is often a rehabilitative goal for home health patients, making it a reasonable evaluation indicator of effective and high-value home health care.

A report on agency performance on this measure is provided to home health agencies (HHAs) as part of the Outcome-Based Quality Improvement (OBQI) Outcome Report. The OBQI reports allow the agency to compare their agency's rates in the current year compared to prior years and to national reference rates (i.e., benchmarking) values. HHAs can use the OBQI outcome measures as part of a systematic approach to continuously improving the quality of care they provide by targeting care practices that influence specific patient functioning and health status. Therefore, the measure is important to making significant gains in health care quality and improving health outcomes for a specific high impact aspect of healthcare where there is variation in performance.

In addition, this measure is reported on the Medicare Home Health Compare Web site External Web Site Policy providing information for consumers and their families about the quality of care provided by individual HHAs, and allowing consumers to see how well patients of one agency fare compared to other agencies and to the state and national average. The Web site presents the quality measures in consumer-friendly language and provides a tool to assist consumers in the selection of an HHA.

Evidence for Rationale

Deitz D. (Abt Associates, Cambridge, MA). Personal communication. 2012 May 18.

Primary Health Components

Home health care; activities of daily living (ADLs); ambulation; locomotion

Denominator Description

Number of home health episodes of care ending with a discharge during the reporting period, other than those covered by generic or measure-specific exclusions (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of home health episodes of care where the value recorded on the discharge assessment indicates less impairment in ambulation/locomotion at discharge than at start (or resumption) of care (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Calendar year 2007 data for 8,953 Medicare certified home health agencies were examined in terms of the level and variability of performance across agencies. For this measure, the median score on the risk-adjusted measure was 40.8 and the coefficient of variation was 30.38. These results demonstrate that room for improvement exists with respect to this quality measure. Considerable variability exists in the performance of agencies on the risk-adjusted measure, suggesting that it captures an aspect of care that is under the agency's control.

Evidence for Additional Information Supporting Need for the Measure

Deitz D. (Abt Associates, Cambridge, MA). Personal communication. 2012 May 18.

Extent of Measure Testing

Validity
As part of the National Outcome-Based Quality Improvement (OBQI) Demonstration project when OASIS was originally designed and tested, several tests of validity were conducted for each OASIS item, including the items used to calculate this measure. The items passed each of the following validity assessments:

  1. Consensus validity by expert researcher/clinical panels for outcome measurement and risk factor measurement
  2. Consensus validity by expert clinical panels for patient assessment and care planning
  3. Criterion or convergent/predictive validity for outcome measurement/risk factor measurement
  4. Convergent/predictive validity: case mix adjustment for payment
  5. Validation by patient assessment and care planning
  6. Validation by outcome enhancement

Descriptions for these validation assessments are contained in the accompanying descriptions taken from Volume 4: OASIS Chronicle and Recommendation (2001).

Reliability
The primary reliability testing for this measure took place as part of the National OBQI Demonstration project when OASIS was originally designed and tested. In spring 1997, 41 patients from two agencies and in fall 1998, 25 patients from three different agencies were assessed by two registered nurse (RN) level assessors who were provided training on assessment methods. The results from these studies are collectively referred to as "Study 1." Study 2 was an independent inter-rater reliability study conducted by Katherine Berg of Brown University (1999) with 144 patients. Study 3 was a concurrent assessment of inter-rater reliability by Madigan, Tullai-McGinness, and Fortinsky (2001) with 88 patients from 21 agencies.

Evidence for Extent of Measure Testing

Goldberg HB, Delargy D, Schmitz RJ, Moore T, Wrobel M, Berg K. Interim reliability report: Medicare home health case-mix project. Appendix G. Case-Mix Adjustment for a National home health prospective payment system. Second interim report. Cambridge (MA): Abt Associates; G.3-G.25 p.

Hittle DF, Crisler KS, Beaudry JM, Conway KS, Shaughnessy PW, West LR, Richard AA. OASIS and outcome-based quality improvement in home health care: research and demonstration findings, policy implications, and considerations for future change. Vol. 4, OASIS chronicle and recommendations. Denver (CO): Center for Health Services Research, University of Colorado Health Sciences Center; 2002 Feb 1.

How to obtain meaningful and reliable results with OASIS data. In: Madigan, Tullai-McGinness, Fortinsky. Presentation at the annual meeting of the National Association for Home Care; October 2001; Las Vegas (NV).

OASIS 2: Home Health Quality Measures - supporting information. [internet]. Cambridge (MA): Abt Associates, Inc., Domestic Health Division; [accessed 2012 Oct 16]. [1 p].

State of Use

Current routine use

Current Use

Accreditation

Decision-making by consumers about health plan/provider choice

External oversight/Medicaid

External oversight/Medicare

Internal quality improvement

Public reporting

Quality of care research

Measurement Setting

Home Care

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Rolling 12 month period

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of home health episodes of care ending with a discharge during the reporting period, other than those covered by generic or measure-specific exclusions

All home health episodes:

  • With an OASIS assessment for both the beginning and end point
  • With an end point that occurs in the reporting year
  • Other than those covered by denominator exclusions

Exclusions
Measure-specific Exclusions

Home health episodes of care for which:

  1. At start/resumption of care, OASIS item M1860 "Ambulation/ Locomotion" = 0, indicating that the patient was able to ambulate independently; OR
  2. The value recorded of OASIS item 1700 "Cognitive Functioning" = 4, indicating that the patient was totally dependent due to disturbances such as constant disorientation, coma, persistent vegetative state or delirium.
  3. The value recorded on M1710 "When Confused" or M1720 "When Anxious" is Not Applicable (NA) on the start (or resumption) of care, indicating the patient is non-responsive; OR
  4. The patient did not have a discharge assessment because the episode of care ended in transfer to inpatient facility or death at home; OR
  5. All episodes covered by the generic exclusions

Generic Exclusions

Home health episodes of care that are exempt from the OASIS reporting requirement, including:

  1. Pediatric home health patients
  2. Home health patients receiving maternity care only
  3. Home health clients receiving non-skilled care only
  4. Home health patients for which neither Medicare or neither Medicare nor Medicaid is a payment source

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of home health episodes of care where the value recorded on the discharge assessment indicates less impairment in ambulation/locomotion at discharge than at start (or resumption) of care

Note: Improvement in Ambulation/Locomotion is coded as follows:

  • 1 (YES) IF: The value recorded for the OASIS item M1860 on the discharge assessment is numerically less than the value recorded on the start (or resumption) of care assessment, indicating less impairment at discharge compared to start of care.
  • 0 (NO) IF: The value recorded for the OASIS item M1860 on the discharge assessment is numerically greater than or equal to the value recorded on the start (or resumption) of care assessment, indicating the same or more impairment at discharge compared to start of care.

Exclusions
Unspecified

Numerator Search Strategy

Episode of care

Data Source

Administrative clinical data

Type of Health State

Functional Status

Instruments Used and/or Associated with the Measure

The Outcome and Assessment Information Set (OASIS) for Home Care

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Risk adjustment devised specifically for this measure/condition

Description of Allowance for Patient or Population Factors

Logistic regression models for risk adjustment were developed using three million episodes of care based on OASIS national repository data from assessments submitted between January 1, 2010 and September 30, 2010.

Details of the model are available from the Home Health Agency Quality Measures: Logistic Regression Models for Risk Adjustment at the Centers for Medicare & Medicaid Services (CMS) Web site External Web Site Policy.

Standard of Comparison

External comparison at a point in, or interval of, time

Internal time comparison

Original Title

Improvement in ambulation/locomotion.

Measure Collection Name

Outcome and Assessment Information Set (OASIS)

Measure Set Name

Outcome-Based Quality Improvement (OBQI) Measures

Submitter

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Developer

Center for Health Services Research, University of Colorado, under contract to Centers for Medicare and Medicaid Services - Academic Affiliated Research Institute

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Funding Source(s)

Centers for Medicare & Medicaid Services

Robert Wood Johnson Foundation

New York State Department of Health

Composition of the Group that Developed the Measure

Peter W. Shaughnessy, PhD; Kathryn S. Crisler, MS, RN; Robert E. Schlenker, PhD; David F. Hittle, PhD; Martha C. Powell, PhD; Angela Arnold Richard, MS, RN; Andrew M. Kramer, MD; Eugene J. Nuccio, PhD; and other staff of the Center for Health Services Research, University of Colorado

Financial Disclosures/Other Potential Conflicts of Interest

None

Endorser

National Quality Forum

NQF Number

0167

Date of Endorsement

2013 Oct 14

Measure Initiative(s)

Home Health Compare

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Mar

Measure Maintenance

Annually

Date of Next Anticipated Revision

Unspecified

Measure Status

Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.

Source(s)

Crisler KS, Hittle DF, Conway KS, West LR, Shaughnessy PW, Richard AA, Powell MC, Lawlor KL, Donelan-McCall NS, Beaudry JM, Baillie LL, Schlenker RE, Engle K. OASIS and outcome-based quality improvement in home health care: research and demonstration findings, policy implications, and considerations for future change. Vol. 3, Research and clinical supporting documents [9 supporting documents]. Denver (CO): Center for Health Services Research, University of Colorado Health Sciences Center; 2002 Feb 1.

Hittle DF, Crisler KS, Beaudry JM, Conway KS, Shaughnessy PW, West LR, Richard AA. OASIS and outcome-based quality improvement in home health care: research and demonstration findings, policy implications, and considerations for future change. Vol. 4, OASIS chronicle and recommendations. Denver (CO): Center for Health Services Research, University of Colorado Health Sciences Center; 2002 Feb 1.

Home Health Quality Measures – Outcomes. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2016 Mar. 10 p.

Shaughnessy PW, Crisler KS, Hittle DF, Schlenker RE, Conway KS, West LR, Powell MC, Richard AA. OASIS and outcome-based quality improvement in home health care: research and demonstration findings, policy implications, and considerations for future change. Vol. 1, Policy and program overview. Denver (CO): Center for Health Services Research, University of Colorado Health Sciences Center; 2002 Feb 1.

Shaughnessy PW, Hittle DF, Crisler KS, Powell MC, Richard AA, Kramer AM, Schlenker RE, Steiner JF, Donelan-McCall NS, Beaudry JM, Engle K, Conway KS, West LR. OASIS and outcome-based quality improvement in home health care: research and demonstration findings, policy implications, and considerations for future change. Vol. 2, Research and technical overview. Denver (CO): Center for Health Services Research, University of Colorado Health Sciences Center; 2002 Feb 1.

Measure Availability

Source available from the Centers for Medicare & Medicaid Services (CMS) Web site External Web Site Policy.

For more information, contact CMS at 7500 Security Boulevard, Baltimore, MD 21244; Web site: www.cms.gov External Web Site Policy.

Companion Documents

The following are available:

  • Department of Health & Human Services, Center for Medicare & Medicaid Services. Home health agency quality measures: technical documentation of OASIS-based patient outcome measures. Baltimore (MD): Center for Medicare & Medicaid Services (CMS); 2013 Jul. 22 p. This document is available from the Centers for Medicare & Medicaid Services (CMS) Web site External Web Site Policy.
  • Department of Health and Human Services, Centers for Medicare & Medicaid Services. Home health agency patient-related characteristics reports: technical documentation of measures. Revision 2. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2013 Jun. 113 p. This document is available from the CMS Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI on October 5, 2004. The information was verified by the measure developer on December 17, 2004 and was reviewed and edited on September 26, 2005. The information was verified by the measure developer on October 15, 2009 and again on May 27, 2010. This NQMC summary was retrofitted into the new template on June 27, 2011. This NQMC summary was updated by ECRI Institute on July 17, 2013. The information was verified by the measure developer on November 14, 2013. The information was reaffirmed by the measure developer on April 7, 2016.

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