Since home health care is the fastest growing sector of the health care system, determining the quality of home health care is essential. However, evaluation of the quality of home health care has been largely idiosyncratic, unstandardized or, until recently, simply ignored. To address the need for a uniform, standardized data set that could be used to evaluate the attainment of specific outcomes, OASIS, a structured assessment tool completed by a nurse 3 or 4 times, as relevant, for each patient was developed. Subsequent to HCFA mandate, OASIS is being used in all Medicare-certified home health agencies. While the implementation of OASIS will certainly assist with the generation of a standardized data set for the evaluation of home health care, it will not contain sufficient information for that evaluation to be sufficiently broad. The proposed project will test a model of quality care that goes beyond that implicitly proposed in OASIS by including structure, process and outcome dimensions and provides for multiple sources of input into the evaluation. If the model is found to be an efficient and effective approach for measuring quality home health care, the knowledge gained about which determinants in the model are the best predictors of patient outcomes will be disseminated to home health administrators, payers, researchers, and clinicians. They may also serve as a national standard for quality assessment in home care.
The aim of this study is to test the ability of the model to predict changes in patient health status between admission and discharge. Secondarily, the scales used to obtain perceptions of the quality of care exchange between provider and patient will be refined and the utility in evaluating quality of care of several well known instruments will be examined. The overall research question is: Does home health care affect patients' self-care abilities at discharge, change in health status between admission and discharge, and change in term health status one month after discharge? This study will be conducted in two sites. All nurses employed in these sites (166) plus 200 nurses employed at a 3rd site will be asked to participate in the study. Over the 3 years of data collection, 925 patients will participate. Data will be collected upon admission to home care (T1), discharge from home care (T2), and one month after discharge from home care (T3). Analyses will include structural equation modeling to identify the best determinants of the health status outcomes for home health patients and evaluating the psychometric properties of the perceptions of quality care scales.
