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Home Health Clinical Measures
Technical Information
Clinical Measures
This website presents information on how well RI Medicare Certified home health agencies provide care for their patients. The agencies collect information about Medicare and Medicaid patients who get skilled care . Information is collected on the patients’ health; how they function; the skilled care and social, personal and support services they need; as well as their living conditions. The information is called the Home Health O utcome As sessment I nformation S et (OASIS ) . Skilled home health care staff gathers the information by observing the patient and the patient’s home situation, and by talking with the patient and caregivers. The measures provide information about patients’ physical and mental health, and whether their ability to perform basic daily activities is improved or maintained. Quality information can help you compare home health agencies.
The quality measures available include:
- Four measures related to improvement in getting around
- Four measures related to meeting the patient’s activities of daily living
- Two measures related to patient medical emergencies
- One measure related to improvement in mental health
What Patients Are Not Included In These Percentages?
The quality measures are based on data collected about home health patients whose care is covered by Medicare or Medicaid and provided by a Medicare certified Home Health Agency. Data collected on patients who are serviced by a Medicaid-only certified agency, pay for their care privately, are under age 18, receive maternity services, or receive only personal care/supportive services are not submitted to the federal government. Therefore, these types of patients are excluded from the measures.
Background Information
Home health agencies provide a variety of services to patients with different needs. The selected measures reflect only a few of the various outcomes of care to represent the care provided by each agency. Each of these measures was chosen because it relates to activities that are important to help you live independently as long as possible in your own home.
The measures are not the only thing to consider when choosing a home health agency. You can talk to your doctor or hospital discharge planners, or ask friends about past home care experiences they have had.
These measures are based on state-of-the-art research. As the research continues, the quality measures posted on this web site likely will be improved.
Patients who are in the hospital or nursing home are monitored by staff 24 hours a day. In contrast, home health patients stay in their own homes and have more freedom and independence. A home health agency’s ability to improve or maintain the health status of a patient depends on the willingness of the patient and his or her family to cooperate and follow the treatment prescribed, even when the home health staff is not in the home. How well a patient improves or maintains his or her level of ability while receiving home health care services reflects both the agency’s quality of care and the patient’s level of cooperation.
Clinical Measure Calculations
The rates for the clinical measures represent the percentage of home care patients who achieved that particular outcome during a 12-month period. To view how these rates were calculated, click here. Rates were calculated only if the agency had at least 20 patients who qualified for the calculation of each clinical measure, as smaller sample sizes might produce rates that are unreliable. Clinical measures that could not be calculated for a particular home health agency due to a small number of patients are labeled not available .
To decrease the chance that a home health agency serving patients who are sicker, older or more frail, looks worse in the quality measures, the quality measures are risk adjusted.
Risk adjustment is a statistical process used to identify and adjust for variation in patient outcomes that stem from differences in patient characteristics (risk factors) from one home health agency to the next. For more information on risk adjustment methods used with home health agencies please visit
http://cms.hhs.gov/oasis/RiskAdj1.pdf. Or http://cms.hhs.gov/providers/hha/RiskModels.pdf.
What the Rates Mean
In order to provide consumers with some guidance in understanding what the actual rates mean when comparing the clinical measures for different home health agencies, a designation of one, two, or three diamonds has been assigned to each rate. These diamond ratings will be reassigned every time the rates are recalculated -- that is, every three months.
Assigning the One, Two, and Three Diamond Ratings
Diamonds were assigned using the following steps:
Each agency’s “observed rate” (i.e., numerator divided by denominator,
multiplied by 100) was risk-adjusted (except for pain), as described in the section, Clinical Measure Calculations. However, because the observed rate was calculated from a sample of patients at just one time point, the possibility exists that the observed rate is above or below the agency’s “true” rate. Thus, an agency could have been assigned inaccurately to the one or three diamond group. To reduce this chance of error, a statistical formula (known as a confidence interval)was used to calculate the range of rates that is likely to contain the agency’s “true” observed rate. A 90% confidence interval was used, meaning there is a 90% chance that the agency’s true score is contained within the range.
Because a confidence interval could not be computed directly on a risk -adjusted rate, a confidence interval was computed on the observed rate and then applied to the risk-adjusted rate. For example, if the observed score was 63%, the risk-adjusted score was 59%, and the confidence interval was +/- 7%, then the range of rates around the risk-adjusted score would be 52%-66%.
No confidence interval was computed around a score of 0%; that score automatically received 1 diamond (except for Any Emergent Care or Acute Care Hospitalization for which lower scores are more desirable).
For each measure, a National Observed Score has been computed, which is the observed rate that is the aggregate rate for all patients served by providers in the United States. For each measure, each agency’s range of rates was compared to the National Observed Score. Agencies whose range of rates contain the national observed score were assigned two diamonds. Agencies whose range of rates was fully below the National Observed Score were assigned one diamond (except for the measures Any Emergent Care and Acute Care Hospitalization, for which lower rates are more desirable; thus, three diamonds were assigned). Agencies whose range of rates was fully above the National Observed Score were assigned three diamonds (except for Any emergent Care and Acute Care Hospitalization, for which one diamond was assigned.)
The figure below illustrates the process:
Figure 1.
Agency A = ◆
Agency B = ◆ ◆
Agency C = ◆ ◆
Agency D = ◆ ◆ ◆
1. Diamond assignments in this illustration apply to all measures except Any Emergent Care or Acute Care Hospitalization . In the case of these two measures, a lower score is more desirable; thus, Agency A would be assigned three diamonds and agency D would be assigned one diamond.
Calculation of Clinical Measures
Home Health Clinical Measures
Clinical Measure |
Numerator |
Denominator |
Excluded from Measure |
Improvement in Transferring |
Number of patients who improved in their ability to ambulate based on OASIS data on OBQI (Outcome Based Quality Improvement) report. |
- Number of patients eligible to improve in transferring.
- Value of MO690 is greater than zero.
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Those patients who were completely independent with transferring at start of care, as these patients could not improve further. Patients who are non-responsive at start of care or whose episodes of home health care end with admission to an inpatient facility or death are also excluded. |
Improvement in the Management of Oral Medications |
Number of patients who improved in their ability to manage oral medications based on OASIS data on OBQI (Outcome Based Quality Improvement) report. |
- Number of patients eligible to improve in their ability to manage their oral medications.
- Value of MO780 is greater than zero.
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Patients who were completely independent in oral medication management, as these patients could not improve further. Patients who are non-responsive at start of care or whose episodes of home health care end with admission to an inpatient facility or death are also excluded. |
Improvement in Bathing |
Number of patients who improved in their ability to bathe based on OASIS data on OBQI (Outcome Based Quality
Improvement) report. |
- Number of patients eligible to improve in bathing
- Value of MO670 is greater than zero.
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Those patients who are completely independent in bathing at start of care as these patients are not able to improve any further. Patients who are non-responsive at start of care or whose episodes of home health care end with admission to an inpatient facility or death are also excluded. |
Stabilization in Bathing |
Number of patients who improved or stayed the same in their ability to bathe per the OASIS data on the OBQI (Outcome Based Quality Improvement) report. |
- Total number of patients eligible to improve or not worsen in bathing.
- Value of MO670 is less than 5.
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Those patients who were totally dependent with bathing at start of care, as these patients could not decline any further. Patients who are non-responsive at start of care or whose episodes of home health care end with admission to an inpatient facility or death are also excluded. |
Improvement In Toileting |
Number of patients who improve in their ability to toilet per the OASIS data on the OBQI (Outcome Based Quality Improvement) report. |
- Total number of patients who were eligible to improve in toileting.
- Value of MO680 is greater than zero.
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Those patients who were totally independent with toileting at start of care, as these patients could not improve further. Patients who are non-responsive at start of care or whose episodes of home health care end with admission to an inpatient facility or death are also excluded. |
Clinical Measure |
Numerator |
Denominator |
Excluded from Measure |
Improvement in Upper Body Dressing |
Number of patients who improved in their ability to dress their upper body per the OASIS data on OBQI (Outcome Based quality Improvement) report. |
- Number of patients eligible to improve in upper body dressing.
- Value of OASIS item MO650 is greater than zero.
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Those patients who were completely independent with upper body dressing at start of care, as these patients could not improve further. Patients who are non-responsive at start of care or whose episodes of home health care end with admission to an inpatient facility or death are also excluded. |
Improvement in Pain Interfering with Activity |
Number of patients whose pain interfered less with their activities based on OASIS data on OBQI (Outcome Based Quality Improvement) report. |
- Number of patients eligible to have a reduction in degree to which their pain interferes with activity.
- Value of MO420 is greater than zero.
|
Those patients who were completely pain free at start of care, as these patients could not reduce their level of pain. Patients who are non-responsive at start of care or whose episodes of home health care end with admission to an inpatient facility or death are also excluded. |
Improvement in Confusion Frequency |
Number of patients who demonstrated a decrease in their frequency of confusion based on OASIS data on OBQI (Outcome Based Quality Improvement) report. |
- Number of patients eligible to decrease their frequency of confusion.
- Value of MO570 is greater than zero.
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Patients who were completely oriented, (i.e., free from confusion episodes) at start of care. Patients who are non-responsive at start of care or whose episodes of home health care end with admission to an inpatient facility or death are also excluded. |
Any Emergent Care Provided |
Number of patients who had an emergent care episode per OASIS data on OBQI (Outcome Based Quality
Improvement) report. |
- All patients are eligible for this outcome.
- Value of MO830 is1, 2 or 3.
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If the value of the MO830 is not 0, 1, 2 or 3 the patient is excluded. Patients who are non-responsive at start of care or whose episodes of home health care end with admission to an inpatient facility or death are also excluded. |
Acute Care Hospitalization |
Number of patients who were admitted to the hospital per the OASIS data on the OBQI (Outcome Based Quality Improvement) report. |
- All patients are eligiblefor this outcome. Patients are included in the numerator if the value of MO855 is 1.
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All patients are eligible for this outcome. Patients who are non-responsive at start of care or whose episodes of home health care end with admission to an inpatient facility or death are excluded. |
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