Improving XXXX outcomes of home health care: findings from two demonstration trials of outcome-based quality improvement.

@entity1 @entity73 @entity1297
OBJECTIVES: To evaluate effects on @entity1 outcomes of @entity1297 ( @entity1297 ), a continuous quality improvement methodology for home health care (HHC). DESIGN: A quasi-experimental design with prospective pre/post and study/control components within two multiyear demonstration trials (occurring from 1995 to 2000) in which 73 home health agencies implemented @entity1297 , receiving several annual cycles of outcome reports to evaluate and enhance @entity1 outcomes. SETTING: New York and 27 other states. @entity1 : The study involved 157,548 predominantly older adult @entity1 admitted over 3 years to 54 @entity1297 agencies from 27 states in the National Demonstration Trial, 105,917 @entity1 admitted over 4 years to 19 @entity1297 agencies in the New York State Trial, and 248,621 @entity1 admitted over 3 years to non- @entity1297 control agencies in the 27 demonstration states. INTERVENTION: As a clinical management and administrative intervention, @entity1297 involves collecting, encoding, and transmitting @entity1 -level health status data to a central source that provides each @entity1297 agency with a risk-adjusted outcome report comparing the agency's @entity1 outcomes with those from a reference population and with its own outcomes from the prior period. Target outcomes are selected and focused plans of action implemented to change care behaviors. Outcome changes are evaluated through the next report cycle. MEASUREMENTS: Outcome measures include hospitalization rates and improvement and stabilization outcome rates in functional, physiological, emotional/behavioral, and @entity73 . RESULTS: For the National and New York State Demonstration Trials, the risk-adjusted relative rates of decline in hospitalization of 22% and 26%, respectively, for @entity1297 @entity1 over the 3-year and 4-year demonstration periods were significant (P <.001) and unparalleled by considerably smaller rates of decline for the non- @entity1297 @entity1 in the 27 states. The risk-adjusted rates of improvement in @entity1297 target outcome measures of health status averaged 5% to 7% per year in both demonstration trials and were significantly greater (P <.05) than analogous improvement rates for nontarget comparison outcomes, which averaged about 1% per year. CONCLUSION: It is feasible to integrate the programmatic, data collection, data transmission, and outcome enhancement components of @entity1297 into the day-to-day operations of home health agencies. The aggregate findings and the agency-level evidence available from site-specific communications suggest that @entity1297 had a pervasive effect on outcome improvement for home health @entity1 . @entity1297 appears to warrant expansion and refinement in HHC and experimentation in other healthcare settings.
