Home Health Clinical Measures

Glossary of Terms

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Activities of Daily Living (ADLs) – Activities you usually do during a normal day. Although definitions differ, ADLs are usually viewed as everyday activities, such as walking, getting in and out of bed, dressing, bathing, eating, and using the bathroom.

Advance Directive – Written ahead of time, this is your statement of how you want to get health care. This is done in case you are unable to say what you want. Such health care could include routine treatments and life-saving methods. You can also choose someone to make medical decisions in case you cannot. Examples of advanced directives include a Living Will, Do Not Resuscitate Orders, and Durable Power of Attorney for Healthcare.

Agency’s Initial Date of Medicare Certification - The date that Medicare certified that an agency met all of its requirements to provide home health care. This date may differ from the date the state licensed the agency. This information is included because you may wish to know how long the agency has met all Medicare requirements to provide home health care services.

Assessment – The gathering of information to rate or evaluate your health and needs, such as when you are admitted to a home health agency. An OASIS ( Outcome and Assessment Information Set, see below) form is completed on all Medicare and Medicaid adult home care patients.

B

C

Care Plan – A written plan of care created with your physician and home health agency staff. It tells what services you will get to reach and keep your best physical, mental, and social well-being. The home health staff keeps your doctor up-to-date on how you are doing and updates your care plan as needed.

Case Mix Report - A graphical or tabular document that provides average values for patient attributes at start of care. Comparative data are provided for either (1) agency case mix for a prior time period, (2) case mix for a reference sample of patients from other agencies, or (3) both of the above. The case mix differences are taken into consideration in producing risk-adjusted outcome reports.

Certification (Certified) – State government agencies inspect health care providers including home health agencies, hospitals, nursing homes, and dialysis facilities, as well as other health care providers. These providers are certified if they pass inspection. Medicare or Medicaid only covers care provided by certified providers.

Community Health Accreditation Program (CHAP) - A national accreditation program that focuses exclusively on the home health industry.

Confidence Interval - An agency’s rate is calculated from a sample of patients at one point in time. If we were to repeatedly pick a different sample of patients, or repeatedly collect the data at different points in time, we would likely get different rates-some higher and some lower. The confidence interval takes into account this “error” in measurement. It is a range of scores that has a certain probability of containing the “true” score. For example, a 90% confidence interval around an agency’s score has a 90% chance of containing the “true” score for that agency. Note: the width of the confidence interval varies with the denominator size (the smaller the denominator, the wider the confidence interval).

CMS (Centers for Medicare & Medicaid Services) – The federal agency that oversees the Medicare, Medicaid, and state Children's Health Insurance Program. CMS works to make sure that the beneficiaries in these programs are able to get highquality health care

Continence – The ability to self-control bladder and bowel.

D

Dementia – Dementia refers to a group of symptoms that are caused by changes in brain function. Signs of dementia include changes in memory, personality, and behavior. Dementia makes it hard for a person to carry out normal daily activities.

Diagnosis – The name for a person’s health problem.

Division of Facilities Regulation – The state agency within the Rhode Island Department of Health that is responsible for ensuring that all state licensed and federally certified health care facilities or providers meet the conditions of the law, the Rules and Regulations of the RI Department of Health, and the Rules and Regulations of the U.S. Department of Health and Human Services. Surveyors at the Division of Facilities Regulation survey home health agencies for deficiencies (non–compliance with state and federal regulations).

E

Eligible Cases - The episodes of care in which the patient had the potential to improve for a specific quality measurement. Eligible cases for the improvement outcomes are those patients whose status at SOC/ROC is not optimal. Cases eligible for stabilization outcomes are those whose status at the SOC/ROC are not at the most severely impaired level for the outcome under consideration.

F

G

H

Health Status - Broadly defined to include physiologic, functional, cognitive, emotional or behavioral health. OASIS assessments address each of these areas.

Homebound - This refers to a patient that normally is unable to leave home. Leaving home takes considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to the barber or to attend religious services. A need for adult day care does not keep you from getting home health care for other medical conditions.

Home Health Aides Services - Services to help you with daily living activities (such as bathing, getting dressed).

Home Health Quality Initiative - (HHQI) Program administered by the Centers for Medicare and Medicaid Services (CMS) that aims to further improve the quality of care for Medicare beneficiaries who use home care through a combination of regulation and enforcement; improved consumer information; quality improvement programs; and collaboration and partnerships to leverage knowledge and resources. Quality information about home health agencies is published on a CMS web site, Home Health Compare.

Hospice – Hospice is a special way of caring for people who are terminally ill and for their family. This care includes physical care and counseling.

I

Improvement Outcome - An outcome measure that assesses whether a specific health status attribute (such as transferring or dyspnea) improves between two specified time points, as measured on the OASIS scale. An improvement measure can not be computed if the patient can not possibly improve (i.e., the patient’s health status is optimal for the attribute of interest at start of care.

Incontinence – Inability to control bladder and/or bowel function.

Informed consent – The person giving consent receives information necessary to make a decision about their care, including information about the consequences of any treatments or services (e.g. risks and benefits, as well as many alternative treatments and their right to refuse treatment).

J

Joint Commission on Accreditation of Healthcare Agencies (JCAHO) – An independent, not-for-profit organization that evaluates and accredits health care organizations and programs in the United States including hospitals, nursing homes and home health agencies.

L

M

Medicaid – A joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Medically Necessary - Services or supplies that: are proper and needed for the diagnosis, or treatment of your medical condition; are provided for the diagnosis, direct care, and treatment of your medical condition; meet the standards of good medical practice in the local area; and are not mainly for the convenience of you or your doctor.

Medical Social Services - Services to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community.

Medicare – The federal health insurance program for: people 65 years of age or older, certain younger people with disabilities, and people with End–Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD).

Medicare-covered Home Health Care Services - Medicare Part A and B covers part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services. Note: You must meet certain conditions.

MO Items - Data items in the OASIS.

N

National Repository - All Medicare-certified HHA are required to encode and transmit OASIS data to the SSA for adult Medicare and Medicaid individuals receiving skilled services. The OASIS information housed in each SSA is uploaded to the national data repository. The national OASIS data repository generates reports containing adjusted quality outcome information regarding the nation’s home health population.

O

OASIS ( Outcome and Assessment Information Set) - The comprehensive set of questions that are completed by a clinician at the time a patient is admitted, re-admitted and discharged from a home health agency. The set of data items are designed to measure (and risk-adjust) patient outcomes in home health care.

Occupational Therapy - Services given to help you return to usual activities (such as bathing, preparing meals, housekeeping) after an illness.

Ombudsman – A supporter for nursing home residents, or residents in any long–term care setting, who works to solve problems between residents and their long–term care setting. Also called "Long-Term Care Ombudsman."The Rhode Island Ombudsman Program is the Alliance for Better Long Term Care, and can be reached at 401-785–3340.

Omnibus Budget Reconciliation Act of 1987 (OBRA) – Changes to the Federal Social Security Act that significantly changed how nursing homes and home health agencies are regulated for Medicare and Medicaid certification.

Outcome - The change in a patient’s status between two or more time points.

Outcome Based Quality Improvement- A model of continuous quality improvement based on an agency’s patient outcomes.

P

Physical Therapy - Treatment of injury and disease by mechanical means, as heat, light, exercise, and massage.

Publicly Reported Measures - 11 quality measures from the OBQI Outcome Report selected for public reporting.

Q

Quality Improvement Organizations(QIOs) - A national network of federally designated organizations that work to ensure the quality, effectiveness, efficiency and economy of health care services provided to Medicare beneficiaries.

Quality Measure - An attribute of care that has been assigned numeric values and can be used to gauge quality of care. The term quality measure is used in CMS’s Home Health quality initiative to identify the OASIS-derived outcomes that are publicly reported.

R

Rehabilitation Services - These are services, such as physical therapy, that will help the individual function at the highest possible level of independence.

Risk Adjustment - A statistical process used to identify and adjust for variation in patient outcomes that stem from the differences in patient characteristics (risk factors) from one home health agency to the next.

S

Skilled Nursing Care - A level of care that includes services that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).

Speech Language Therapy - Treatment to regain and strengthen speech skills.

Stabilization Outcome - An outcome measure that assesses whether a specific health status attribute does not worsen between two time periods, as measured on the specified OASIS scale. A stabilization measure cannot be computed if a patient’s health status is at the most severely impaired level at SOC (i.e., the patient can not demonstrate worsening).

Start of Care (SOC) - The time point when the home health agency initiates care and conducts a comprehensive assessment.

T

Type of Ownership- Home health agencies can be run by private for-profit corporations, non-profit corporations, religious affiliated organizations or government entities. Quality can vary in home health agencies within each of the different types of ownership. Each needs to be judged on its own merits.

U

Utilization Outcome - A type of health care utilization (or “non-utilization”) that reflects a change in patient health status over time. Example of utilization outcomes are a hospital admission, use of emergent care services, and discharge to the community.

V

W

X

Y

Z