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Adverse Event Outcome - OBQM - Outcome Based Quality Management One of the new publicly reported measures is known to home health agencies as an adverse event. The Agency Adverse Event Outcome Report, displays incidence rates for infrequent untoward events (outcomes) comparing the agency to a reference sample. The Quality Measure 'Emergent Care for New, Infected, or Deteriorating Wound/Lesion' will be based on the average for all episodes of care that end within a one-year period for this Outcome Based Quality Measure. The state and national rates are aggregated directly from patient-level data, which is equivalent to using the exact agency rates weighted by the number of cases for each agency. Adverse Events are not currently risk adjusted, as explained in the OBQM manual, page 3.1. In the past because these numbers were so small the risk adjustment model was not applied, CMS will explore and work with our researchers to determine the feasibility to do so. High-priority adverse event outcomes are: (a) those with the most clinical relevance to the agency, and (b) those with the highest incidence as compared to the reference group. (Statistically Significant) An "ideal" adverse event outcome for early investigation will meet both of these criteria. Adverse events serve as markers for potential problems in care because of their negative nature and relatively low frequency. It is important to emphasize the word potential in this definition. Whether or not an individual patient situation results from inadequate care provision can only be determined through investigation of the care actually provided to specific patients. A home health agency's ability to improve or maintain the health of their patients partly depends on a partnership with the discharging and community physician, the ability and willingness of patients and their families to help themselves and follow the orders and treatment prescribed, even when the home health staff are not in the home. How well a patient improves or maintains their level of ability while getting home health care reflects both the agency's quality of service and the patient's ability to assist with the plan of care. A few adverse event outcome measures rely on the occurrence of an emergent care encounter for specific reasons as an indicator of change in health status. These provide some of the detail behind the overall emergent care score. Case mix refers to the characteristics of the patients for whom a home health agency provides care. The case mix report presents a picture (or snapshot) of what a home health agency's patients look like at the beginning of a care episode. (The beginning of a care episode is marked by either a start of care or a resumption of care following an inpatient stay.) These reports and the related investigation of care processes help agencies move beyond hunches in evaluating quality of patient care. Now you are able to expand quality monitoring programs to incorporate an examination of the effects of care on patients. These reports represent an important first step in truly using outcome data for quality improvement. The case mix and adverse event outcome reports thus can be used by both HHA and by the State survey agency to assess the quality of care provided to an HHA's patients. Agencies are strongly encouraged to take advantage of the information presented in the reports for their ongoing quality-monitoring program. This page also holds the downloads available for the three part manual and the Technical Documentation for the OBQM measures. 1. Quality Monitoring Using Case Mix and Adverse Event Outcome Reports This is a 5-section document that describes the OASIS-based reports that are available as well as the sources of information for the reports. It is designed to help home health agencies make use of the reports for monitoring and improving quality of care. 2. Accessing Outcome-Based Quality Monitoring Reports This document provides information to obtain Case Mix Reports and Adverse Event Outcome Reports from the OASIS state system that home health agencies already use to submit OASIS data. It describes how to request a report, how to view a report online, and how to print or save a report. 3. APPENDIX: Guidelines for Reviewing Case Mix and Adverse Event Outcome Reports This document describes in detail the component parts of the Case Mix and Adverse Event Outcome Report, and provides definitions of key terms that are essential to understanding and using the reports. It is presented as a technical appendix to the User's Manual, but can also be used as a standalone reference document. This document is formatted for two-sided printing. 4. This Technical Documentation of OBQM Measure on the adverse event and case mix reports specifies how to calculate each measure using OASIS data and OASIS data specifications.
Page Last Modified: 09/03/2008 12:58:46 PM
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