OASIS OBQI

OASIS OBQI/Outcome-Based Quality Improvement Reports

This page briefly describes the reports that can be used by agencies as part of their Outcome-Based Quality Improvement (OBQI) efforts - the Outcome Report, the Agency Patient-Related Characteristics Report, and the Patient Tally Report. It also holds the Outcome-Based Quality Improvement (OBQI) Manual (under Downloads below) which explains the reports in detail, discusses their use for quality improvement purposes, and provides step-by-step guidance on implementing the OBQI process.

The OBQI Outcome Report includes 37 risk-adjusted outcome measures, derived from OASIS data, which measure changes in a patient's health status between two or more time points. An example of an OASIS-based outcome measure is whether a patient improves in the ability to ambulate independently between home health start of care and discharge, with ambulation ability measured according to the precise zero-to-six scale in the OASIS-C ambulation item. The OBQI Outcome reports provided to agencies include a series of outcomes for their patients in the current year, compared to prior year and to national reference (i.e., benchmarking) values. HHAs can use the OBQI outcome measures as part of a systematic approach to continuously improving the quality of care they provide. By focusing quality improvement activities on select target outcomes, they can investigate the care processes that contributed to these outcomes, and make changes in clinical actions that will lead to improved patient outcomes. If the agency carefully implements the steps in this process, this change in patient outcomes is expected to be evident when the next Outcomes Report is accessed.

The Agency Patient-Related Characteristics Report (formerly the Case Mix Report) presents a "snap shot" of agency patient characteristics at the start or resumption of care, and discharge information including home health length of stay and need for emergency or hospital care. It shows patient attributes or circumstances that are likely to impact health status, such as a patient's environmental or living conditions, demographics, and baseline health status. For the report, individual (patient-level) characteristics information is aggregated to the agency level to describe the health status of all the agency's patients at admission/resumption of care. It allows an agency to compare the characteristics of their patients to both a national reference sample, and to their patients during a prior time period (after the first report). The Agency Patient-Related Characteristics Report is discussed in detail in the OBQM manual. The OBQI manual goes into more depth on the use of the report for quality improvement and enhancement efforts.

The Patient Tally Report provides descriptive information for each individual case included in the agency's Outcome Report analysis (e.g., value on the bathing scale or presence of an acute cardiac condition). The primary use of the Patient Tally Report is to select cases for the agency's process of care investigation to identify specific care processes that can be remedied or reinforced.

The Outcome-Based Quality Improvement (OBQI) Manual focuses on the use of the OBQI Reports for quality/performance improvement. The manual provides additional background and context on OBQI (and OASIS) and then proceeds to discuss the steps and activities of outcome enhancement in detail in the remaining chapters. Chapters discuss interpretation of the OBQI Reports, selecting target outcome(s), activities involved in the investigation-of-care processes that lead to specific outcome results, developing and implementing a written plan of action to modify care delivery, and internal agency processes and training important for successful implementation of outcome enhancement. The manual concludes with a summary of strategies important for establishing an effective OBQI system. Multiple learning activities and approaches are included within the specific chapters. Frequently-Asked Questions, for example, are presented at the end of each chapter.

Appendix A includes "How-to Read" guidelines for the Outcome, Agency Patient-Related Characteristics, and Patient Tally Reports. Key terms related to OBQI are defined in Appendix B.

• Note: The OBQI Manual is part of a series of four manuals produced by the Centers for Medicare & Medicaid Services (CMS) to assist home health agencies in the collection and use of OASIS data for quality/performance improvement. The other three manuals are available on the CMS website and include the Outcome and Assessment Information Set (OASIS-C) Guidance Manual, the Outcome-based Quality Monitoring (OBQM) Manual, and the Process-based Quality Improvement (PBQI) Manual. These manuals are provided as downloads on the pages listed on the left side of this page as follows: OASIS –C Guidance Manual on OASIS User Manuals; PBQI Manual on OASIS PBQI / PROCESS MEASURES; OBQI Manual on OASIS OBQI; OBQM Manual on OASIS OBQM.

Accessing the OBQI Measure Report from the CASPER System

The OBQI Reports represents an aggregation of OASIS-C patient status data collected at the beginning and the end of an episode of care. Since HHAs only submit OASIS-C data on Medicare and Medicaid patients, those are the only patients included in the reports. The CASPER User Manual provides information on how to obtain OBQI Reports from the CASPER system. It describes how to request a report, how to view a report online, and how to print or save a report. This manual can be found on each HHA's OASIS State Welcome Page. Chapter 2 (Functionality) of the CASPER User Manual is available in the Downloads section below.

Reporting Timetable

The OBQI Reports will be in transition between September 2010 and May 2011, while sufficient OASIS-C data are collected and risk models are developed. During that time, the reports available in CASPER will be based on OASIS-B1 data collected prior to January 1, 2010. Once the static period is over, the previous measure reports based on OASIS-B1 data will be replaced with the new OASIS-C based measure reports. An explanation of the time table for this transition can be found on the Quality Measures page, accessed via the link list on the left side of this page.

Technical Documentation for the OBQI measures

The Technical Documentation for the OBQI measures, specifying how to calculate each measure on the OBQI Outcome Report using OASIS data and OASIS data specifications, will be posted once those specifications are finalized.