Home Health & Hospice

New and Revised Manuals from CMS

Homecare Insider, October 25, 2010

CMS has issued revised editions of the Outcome-Based Quality Improvement (OBQI) Manual and the Outcome-Based Quality Monitoring (OBQM) Manual. Homecare providers should have been utilizing these manuals long ago, but due to the changes related to OASIS-C, it is important to access, download, and share the new versions. These manuals are two of the four manuals in the series that CMS provides for agencies to utilize in their quality improvement program. 

The OBQI manual describes the OBQI report in detail and is intended to assist homecare agencies in using the data in the report and implementing the steps in outcome-based quality improvement. Its focus, though, is on the use of the Outcome Report for quality/performance improvement. The manual covers interpreting outcome reports, selecting target outcomes, conducting process-of-care investigations, developing plans of action, implementing and monitoring plans of action, teamwork, OBQI education for agency staff, establishing an OBQI system, and guidelines for reviewing OBQI reports. 
The OBQM Manual focuses on the reports generated from the transmission of OASIS data intended for use in a homecare agency’s quality improvement program. The two reports discussed in this manual have been renamed and include the Agency Patient Related Characteristics Report (formerly known as the Case Mix Report) and the Potentially Avoidable Event Report (formerly known as the Adverse Event Outcome Report).  The Agency Patient Related Characteristics Report presents characteristics of an agency’s patients at start or resumption of care. The Potentially Avoidable Event Report displays incidence rates for infrequently occurring untoward events (outcomes). This manual discusses each of these reports, in detail, and their use for quality monitoring purposes. The manual also includes guidelines for reviewing these reports.
The new manual available to providers is the Process Based Quality Improvement Manual (PBQI). This manual describes the Process Quality Measure Report in detail and discusses its use for quality monitoring purposes. The Process Quality Measures Report provides home health agencies with opportunities to use process measures for process-based quality improvement purposes, following a three step process:
1.        Evaluating or investigating the use of specific best care processes (such as conducting falls risk assessments or providing drug education) by reviewing the care provided to determine any needed changes in care delivery,
2.        Systematically documenting recommendations for change in a written plan; and
3.       Thorough implementation and continual monitoring of the plan in order to effectively change care delivery.
Included in the PBQI manual are chapters relating to the use of process quality measure reports, investigating process quality measures, and the overall role of these reports in the agency’s quality program.
These three manuals, along with the OASIS-C Guidance Manual comprise the series of four CMS-produced manuals and should be part of all homecare agencies quality programs.
Beacon Health offers several products to assist homecare agencies with their Quality Improvement programs; they include Headstart to Quality Improvement in Homecare, OASIS-C Process Measures, and Homecare Audit Prevention—all available on the Beacon Health website at http://www.beaconhealth.org.