^The  Geriatrics Forum

Focus - Continued from Page 1
An integrated research program conducted over the past 15 to 20 years at CHSR has recently led to Medicare's new nationwide approach to outcome-based quality improvement (OBQI) in home health care. Essential to OBQI is the Outcome and Assessment Information Set (OASIS), a set of standardized patient-level assessment items now routinely collected by all Medicare-certified home health agencies. Using OASIS, annual reports are provided to all certified home health agencies in the United States. These reports display aggregated, risk-adjusted patient outcomes that permit an agency to compare its outcomes with all others in the U.S., and with its

own prior year's outcomes. The outcome measures, statistical risk adjustment methods, OASIS data set, and outcome enhancement approaches used in OBQI were developed by CHSR. Other ongoing home health research and related activities include:

vResearch and educational support in a 400-agency pilot system in five states that involves Quality Improvement Organizations (formerly Peer Review Organizations or PROs) facilitating the implementation and maintenance of OBQI.

vA multi-site research and demonstration program to develop the methodology for and test the effectiveness of OBQI for

non-certified home care agencies in New York State.

vA project that has resulted in a national reference database and a CHSR-sponsored public service program to facilitate accreditation and provide outcome, case mix, and adverse event reports to approximately 500 home health agencies. This project now has produced a longitudinal research database on well over one million patients.

Another large-scale research effort at CHSR focuses on developing an outcome-based continuous quality improvement (OBCQI) system for the national managed care program entitled the Program of All-Inclusive Care for the Elderly (PACE). OBCQI is similar to OBQI but encompasses the broader array of (institutional and non-institutional) medical, nursing, rehabilitative, and social services provided under PACE. The study has entailed developing a comprehensive assessment instrument, which yields enrollee-level data to be employed in OBCQI reporting and outcome enhancement, and in assisting with ongoing assessment of PACE enrollees.

An integrated research program
at CHSR has recently led to
Medicare's new nationwide
outcome-based quality
improvement in home health care.

CHSR activities also include a study to recommend alternative approaches to telemedicine and telemedicine technologies for consideration under the Medicare payment system, and a study of the effects of androgen blockade on cognitive function and quality of life in men with prostate cancer. Earlier work has included studies of nursing home quality, case mix, utilization, and costs, as well as evaluations of long-term care provided in acute care beds in rural hospitals.

For further information on the Center for Health Services Research, contact Dr. Shaughnessy or Dr. Schlenker at 303-756-8350.