Measuring and Reporting Outcomes in Home Care

Joan Kohorst, MA, RRT

Apria Healthcare

AARC Home Care Section Chair

What Is Outcomes Measurement? It looks at…

Input: resources used to achieve objectives (staff, facilities, equipment, money)

Activity: how the input is used to achieve objectives

Output: product of the activity (patients seen, equipment used, money saved)

To Measure…

Outcomes Benefits achieved during or after the

program or process May relate to knowledge, skills, cost,

profit, health status, quality of life Must be observable and measurable

Input Activity Output Outcome

Resources:

Money

Staff

Time

Facilities

Equipment

Constraints:

Laws

Regulations

Set-ups

Education

Treatments

Documentation

Numbers New knowledge

New skills

Modified behavior

Improved condition

Reduced cost

Increased profit

Why Measure Outcomes?

To see if a program or process really makes a difference to patients, customers, payers or to the organization

Anecdotes and “warm fuzzy feelings” are not enough anymore

We need to prove it

Proving It Can Help…

Recruit and retain staff Attract new customers (patients,

physicians, payers) Retain or increase reimbursement Enhance public image

Home Care Organizations Can Use Outcomes to…

Strengthen existing services Target effective services for expansion Identify staff training needs Develop and justify budgets Prepare long range plans Affect cost savings

Limitations of Outcomes Measurement Outcome findings don’t show where

problems lie or how to fix them Not a substitute for blinded,

controlled, pure research, subjected to sophisticated statistical methods

It’s not free

How Does the Process Work?

Get ready Choose the outcomes

to measure Specify indicators Prepare to collect

data

Trial the system Analyze and report

findings Improve the system Use the findings

Get Ready

Decide to implement outcomes measurement

Assemble and orient the “work group” Decide which program to target Communicate with the key players

Choose Outcomes to Measure

Gather ideas from a variety of sources Measure important outcomes

Have recognizable and defined mission and clientele

Represent a substantial portion of your business Are of interest to your paying customers The staff will support

Get feedback

Process v. Outcomes

Measure outcomes, not process Process is the work performed

Activities of the program Actions taken to deliver the services

Outcomes are the changes that occur because of the activities and actions

Specify Indicators

Indicators must be observable and measurable

They must be unambiguous Should be at least one indicator for

each outcome

Examples of Good Indicators

Knowledge gain Behavior change Skill gain Attitude change Status change Money saved

Measuring Knowledge Gain

Type of program: asthma intervention Desired outcome: recognize early signs

and symptoms of asthma Indicator:

x% of all participants will be able to identify the early signs and symptoms of asthma on a written post-test

Measuring Behavior Change

Type of program: smoking cessation Desired outcome: stop smoking Indicator:

x% of all participants will have stopped smoking by the end of the program

x% of all participants will not relapse six months after the program

Measuring Skill Gain

Type of program: COPD intervention Desired outcome: self administer

medication Indicator:

x% of all participants who could not self-administer their breathing medications will be able to administer their medication by the end of the program

Measuring Attitude Change

Type of program: pulmonary rehabilitation

Desired outcome: cope with COPD Indicator:

x% of all participants report feeling better able to cope with their COPD than they did before completing the program

Measuring Status Change

Type of program: CHF disease management

Desired outcome: decreased hospitalizations

Indicator: x% of all participants who successfully

complete the program will not be hospitalized for CHF within six months of completing the program

Measuring Money Saved

Type of program: CHF disease management

Desired outcome: money saved Indicator:

cost of hospitalizations for participants six months before successfully completing the program compared to cost of hospitalizations for the six months after completing the program

Prepare to Collect Data

Identify data sources for your indicators Design data collection methods Pre-test the data collection tools and

procedure

Good Data Sources

Records People (participants, patients,

physicians, referrals) Trained observers (RTs, RNs) Objective tests (vital signs, SpO2,

written tests) Surveys, interviews, questionnaires

Designing Data Collection Tools

Don’t recreate the wheel Keep it simple Don’t collect data because “it would

be nice to have” See if it works, trial it with a small

group

Qualities of Good Measurement Tools

Reliable Valid User-friendly and culturally sensitive Pilot tested

Ideas for Tools

Type of program: smoking cessation Indicator: number and percent of

participants who reported that they have stopped smoking by the end of the program

Data collection ideas: direct observation, telephone survey, follow-up mail survey

Analyze and Report Findings

Record the data and check for errors Provide explanatory information related

to the findings Present the data in clear and

understandable form Make it accessible

Improve

Review the trial-run experience Make necessary adjustments Start full scale implementation Monitor and review the data

collection system periodically

Internal Uses

Provide direction for staff Identify training and technical

assistance needs Identify program or operational

improvement needs and/or successes Support annual and long-range

planning Guide / justify budgets

External Uses

Recruit talented staff Promote programs to customers Enhance public image Retain and/or increase reimbursement

Let’s Get Practical

Performance improvement Audit to identify how well your organization

is complying with written policies or standards

Score Address deficiencies Train, re-audit, re-score Repeat

Let’s Get Practical JCAHO and other accrediting organizations Accreditation required for participation in

the CMS Competitive Bidding process Survey to identify how well your organization is

complying with standards Score Address deficiencies

Submit Evidence of Standards Compliance (ESC) Submit quantifiable Measures of Success (MOS) data that

shows compliance has been sustained over time

Let’s Get Practical Pay for Performance (P4P)

CMS initiative to encourage improvements in the quality of care provided to Medicare beneficiaries.

Improve health care quality, outcomes or safety by rewarding improvements based on measurements of quality, efficiency and outcomes

Expected outcomes: fewer ED visits, fewer hospitalizations, significant cost savings

Coming soon to a HH agency near you

Let’s Get Practical

Measure productivity AARC Benchmarking Project Paid hours per unit of service

Take care how you measure and report “data indicated that we should eliminate 48 of

the 56 FTEs in order to realize the required savings opportunity” May 2006 AARC Times

Let’s Get Practical

Measure productivity Justify staffing levels

Patients seen / day Meet financial goals

Labor is expensive Use it wisely or lose it

Let’s Get Practical

Competitive Bidding will require participating providers to: Track and publish complaints and

complaint resolutions Track and publish specific patient

satisfaction metrics

Let’s Get Practical

Sue Percival, Hastings Home Health Center, Cleveland Built a successful pediatric vent program Collected data on outcomes, QOL and cost Presented data to Ohio Medicaid and convinced

them to increase reimbursement

“Paying the increased amount / month will still save Medicaid thousands by getting the pt home and out of the costly hospital”

Sept 2006 AARC Times

Outcomes and Quality

It is vital that we understand how to collect, measure and report quality indicators and outcomes data

We need more evidence-based, peer reviewed publications that quantify health and economic outcomes

Why Bother?

Outcomes measurement requires effort and an investment in resources

Evidence-based outcomes are essential to help defend against cuts and changes in reimbursement methods

Questions?

Joan_Kohorst@Apria.com