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  • Measure Summary
  • NQMC:007636
  • Mar 2016

Home health care: percentage of home health episodes of care during which the patient's toileting hygiene improved or stayed the same as at admission.

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

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's toileting hygiene improved or stayed the same as at admission.

Rationale

Patients need certain physical abilities and capacities (motor skills, symptom relief) to manage toilet hygiene. Many patients who receive home health care may have chronic illnesses or disabilities that lead to difficulty performing the tasks of self-grooming, and/or may need help from another person or special equipment to accomplish this activity. Good toileting hygiene can reduce the risk of urinary tract infections and other infections related to inadequate hygiene. Maintaining toileting hygiene reduces the risk of preventable health-care associated infections. High-quality home health care will reinforce toileting hygiene and protect patients against the development of a urinary tract infection (UTI) during care. Stabilization in in toileting hygiene is a rehabilitation goal for some patients and can be an indicator of effective high-value 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.

Analysis of measure scores demonstrates that 1) there is room for improvement with respect to this quality measure; and 2) 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 Rationale

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

Primary Health Components

Home health care; activities of daily living (ADLs); stabilization; toilet hygiene

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 the same or less impairment in toileting hygiene 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

Additional Information Supporting Need for the Measure

Unspecified

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 development of the measure, the following validity assessments were conducted:

  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

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

External oversight/Medicaid

External oversight/Medicare

Internal quality improvement

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

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 M1845 "Toileting Hygiene" = 3, indicating the patient had the maximum level of dependency in toileting hygiene; 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 the same or less impairment in toileting hygiene at discharge than at start (or resumption) of care

Note: Stabilization in Toileting Hygiene is coded as follows:

  • 1 (YES) IF: The value recorded for the OASIS item M1845 on the discharge assessment is numerically less than or equal to 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 M1845 on the discharge assessment is numerically greater than 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

Stabilization in toileting hygiene.

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

Acumen LLC, under contract to Centers for Medicare and Medicaid Services - Nonprofit Research Organization

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

Composition of the Group that Developed the Measure

Acumen LLC: Keziah Cook, PhD; University of Colorado Denver: David F. Hittle, PhD; Angela Arnold Richard, MS, RN; Eugene J. Nuccio, PhD; Abt Associates Inc: Henry Goldberg and Deborah Deitz; Case Western Reserve University: Elizabeth Madigan, PhD

Financial Disclosures/Other Potential Conflicts of Interest

None

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)

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

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 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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