Educational Objectives
1. Explain why Emergent Care and re-Hospitalization are powerful nurse sensitive indicators for the Homecare patient population.
2. Describe the current and future business implications of these two publicly reported clinical outcomes and one approach to managing the outcomes at the unit level.
Purpose
This session will provide relevant and current knowledge of two powerful nurse sensitive indicators for patients in the Homecare setting. The presentation will describe the method that one large homecare department utilized to improve its publicly reported outcomes, utilizing a nurse-led, disease management approach to the Heart Failure population of homecare.   
Summary of Presentation
Publicly reported patient outcomes will soon transition from quality indicators for consumer reference to indicators of business performance upon which future reimbursement will be modeled. Nurses in all patient settings need to fully understand the business case for public reporting of patient quality outcomes.

In 2000, the federal government began requiring that every Medicare-certified home health agency (approx 9,000 agencies nationwide) complete and submit health assessment information for their clients upon admission and discharge from any Medicare or Medicaid funded episode of care. The instrument/data collection tool used to collect and report performance data by home health agencies is called the Outcome and Assessment Information Set (OASIS). Since Fall 2003, CMS has posted on www.medicare.gov a subset of OASIS-based quality performance information showing how home health agencies perform on certain core ADL measures as well as measures of physical status and two use-of-service measures : Emergent care and Hospitalization.

These indicators of quality are now accessible to consumers, insurers and referral sources of home health agencies, therefore influencing choice. OASIS will remain in use in the foreseeable future and not only be publicly reported but will serve as a basis for several new priorities including Pay for Performance – tying a portion of reimbursement to delivery of care that has been proven to be effective.

Since the majority of  all care delivered by home health agencies is nursing care, the indicators of Emergent care and Hospitalization are “nurse sensitive” for a typical home health agency. This presentation outlines a nurse led approach to improve publicly reported outcomes (compared to internal, state and national benchmarks) taken by a large, hospital- based home health agency. The nursing leadership analyzed OASIS data and used the data to support a new delivery model of specialty- team management for its Heart Failure population (#1 volume diagnosis)

Throughout the design and development of a new model of care, a select team continuously monitored its patient outcomes for Emergent Care and Hospitalization for the Heart Failure population. Results showed significantly lower rates than national and state benchmarks for both measures and the team continues to modify its practice to improve the outcomes.Implications for Practice

The presentation provides concrete examples of how publicly reported indicators may be used to drive practice changes that improve patient quality and business performance.

The presentation poses possible expansion of the NDNQI data base for nursing units and nurse sensitive indicators which are not currently included in the database.