To monitor and improve the quality of home health care provided by Medicare-certified Home Health Agencies (HHAs), all such agencies uniformly collect clinical data using the Outcome and Assessment Information Set (OASIS). Since 1999 the Medicare Home Health Conditions of Participation have required HHAs to use OASIS when evaluating individual patients. Aggregate patient outcomes are then derived from OASIS data and made available to HHAs through outcomes-based quality improvement and monitoring reports, and to the general public through the CMS Home Health Compare website. CMS has contracted with Abt Associates to revise, expand, and enhance the instrument used to collect OASIS data. A particular focus of this revision will be to incorporate evidence-based practices that have been shown to prevent exacerbation of serious conditions. The research tasks also include analyzing and testing the OASIS instrument as a whole, individual elements of it, and its risk-assessment methodology; proposing methods to establish performance-based industry benchmarks; and developing measures of quality-based efficiency within the home health industry.

Abt Associates will incorporate existing standards and measures, and identify others for potential inclusion in OASIS — including systems to strengthen the delivery of the basic services that each at-risk patient needs while homebound. CMS wants to make progress in standardizing measures of health care quality across settings. Thus, rather than creating clinical guidelines that are unique to home health, the research will help to delineate and clarify the role of home health care providers in ensuring that patients receive care that is based on current science, and interventions that are known to improve outcomes.

The work also involves developing a method of collecting and reporting data to reflect change in patient condition for all patients who experience home health care, thus addressing gaps in the current reporting system that occur because of the 12-month period used for reporting OASIS-based outcomes (that is, reporting outcomes of a patient only if care both starts and ends within a 12-month period.) The current system thus works well to capture outcomes for the typical short-term, acute care patient, but not for long-term patients with complex needs. CMS is particularly interested in collecting data elements that the agency can then use to measure the performance of HHAs in caring for patients with multiple chronic conditions.

This research is being conducted as Task Order 2 of a Medicare/Medicaid Research and Demonstration Task Order contract. Under this master agreement, CMS awards task orders for a wide range of research, demonstration, analysis, and survey activities.