One would be hard pressed to find a practicing clinician today that does not include a foundational evidence-based approach to his or her practice. We are all aware this combined approach of research and experience leads to delivering a better quality of care for our patients.
So, if our clinical practice is evidence-based, why are many quality improvement (QI) programs not? The question each QI director and all agency leadership should be prepared to answer is, ‘What evidence is guiding your QI changes?’ Although most seasoned homehealth-ers will have a ‘gut’ feeling of the direction, they think their QI efforts should be focused, but does the evidence support this? Before performing chart audits and deciding where to focus your efforts and time on improving your agency’s disease management program vs. medication management program vs. infection rates, a more basic assessment needs to be completed: DATA. What do your data indicate?
Each CMS-Reporting home health agency has access to three data sources – Home Health Compare, CASPER (Certification and Survey Provider Enhanced Reports), and the HHQI Data Reports. All three are free, available and should be viewed by someone in each agency every month.
When looking at the available data, have you wondered what the difference is between the three data sources? If so, see below for the basic breakdown. All three are valuable in their own way and combine to offer a rounded approach towards guiding your QI program.
As we at HHQI work with different agencies, the initial comments we hear when the HHQI Data Reports are first viewed is one of surprise. Most are not expecting the data to reveal such obvious areas in need of attention. It may be the day of the week with the most hospitalizations or which payer source or age group of patients has the highest hospital admission rate for their agency or even the age group with the highest and lowest medication management improvement rates.
When viewing any data report, the first three questions that must be answered are:
- What is the source of the specific data report and what do the data represent – OASIS, claims data, something else?
- Inclusion/exclusion criteria for the measure.
- When looking at comparisons (national, state, county, etc.), what does the comparative group represent?
The most important rule to remember when viewing any data report is that data should not be the sole driving force of your quality improvement process. Only you at the agency and in the patient’s home will have the true picture. The data will give you direction. With that in mind, we should all be striving for “clean data”, meaning the most truthful data possible. The reports are only as good as the data it is representing. There is an old saying in the data world – garbage in, garbage out.
The interpretation of the OASIS questions and response can have a large impact on your data.
How are you or your clinicians answering M2020? This will play an important role in your Oral Medication Report. If you are not sure, HHQI offers a short and simple case study you can use during a staff meeting to get a quick answer.
How about M2430 – Reasons for Hospitalization? What percentages of your patients are assessed as being admitted to the hospital for “Other Than Above” and / or “Reasons Unknown”? Unless you have found a way to have unlimited resources and time, it’s important to focus improvement changes on the areas of most need. It will be difficult to make disease management decisions and changes without having “clean data” and knowing which disease process needs the most immediate attention.
Data to some are drab, boring and complicated where as others will find it challenging and rewarding. Regardless of how you feel about data, HHQI is available to help you understand these numbers and assist you identifying those areas where to best focus your QI efforts as we all strive to improve the quality of care home health patients receive.
|Report||Data Source||Public vs. Private||Pros||Cons||Additional Resources|
|Home Health Compare||OASIS and Claims Data||Public||-Data are Risk Adjusted-Accessible anywhere internet is available
-National and State comparisons
-Lack of depth in reports when QI program trying to “drill down” for cause and effect
|CASPER||OASIS||Private||-Data are “raw” – it’s exactly as agency transmitted to CMS
-Wide breadth of reports and available information
|-Lacks depth in reports when QI program trying to “drill down” for cause and effect
-Only accessible through the one CASPER computer located at the agency
|HHQI Data Reports||OASIS||Private||-Data are both “raw” and risk adjusted
-Depth of data for distinguishing cause and effect (7-10 tables of data on each topic)
-Data available dating back to 2009
-Accessible anywhere internet is available
-National and State comparisons as well as Percentile Rankings
|Focus limited to
-Oral Medication Management Improvement Rates
-Immunization Rates (coming soon)