OASIS-Central

For almost nine years, homecare providers have been getting reports on their agency’s adverse event outcomes as part of Outcome-based Quality Monitoring (OBQM). From the beginning, many realized there could have been a better name for this outcome. Adverse means something harmful or unfavorable occurred. However, according to the official definition, each event, because of its negative nature or relatively low frequency, served as a marker for potential problems in care delivery. It was not necessarily a bad thing when an outcome showed up on an agency’s OBQM report. However, because selected adverse event outcomes are part of the enhanced survey protocol, these outcomes could create problems for an agency. Agencies found it necessary to investigate the circumstances so they could explain what happened in case a surveyor asked.

The implementation of OASIS-C will bring some changes to OBQM. The most notable is a change in name. Adverse event outcome is now a potentially avoidable event. It appears that this event will remain a marker of a potential problem in care delivery, so the title is still not an accurate description of the outcome. “Potentially avoidable” implies that the event could have been avoided. However, the event might not really have been an event after all, so agencies will still need to investigate the circumstances.

Potentially avoidable events can be looked at as outcome measures, representing a change in health status between start or resumption of care and transfer or discharge. Some potentially avoidable events are related to actual outcome measures found in the OASIS, such as a decline in the management of oral medications. A few rely on emergent care for a specific reason, such as injury caused by a fall. (With the change in focus to hospital emergency room visits, agencies will likely see a decrease in potential avoidable events related to emergent care.) Three look at the patient’s potential problematic status and situation at time of discharge. Example: Discharged to community needing assistance with toileting.

OBQM will report 12 potentially avoidable events, one less than the number generated from OASIS B-1 data. Several original events remain. There is one new event, discharged to community with an unhealed Stage II pressure ulcer present for more than 30 days. Two adverse event outcomes from OASIS-B1 are gone: unexpected death and unexpected nursing home admission. OASIS-C deleted the underlying data elements. However, from a clinician’s standpoint, these were way too subjective and did little to facilitate care planning or delivery. Also note one name change. Increase in the number of pressure ulcers has become increase in the number of unhealed pressure ulcers.

The implementation of OASIS-C will change the reporting of potentially avoidable events on the Home Health Compare (HHC) Web site. There were three adverse event outcomes generated from OASIS-B1 data, acute care hospitalization and two related to emergent care. There will be only one event generated from OASIS-C, that being an increase in the number of unhealed pressure ulcers.

CMS will likely issue more information about these potentially avoidable events, possibly as an update to the OBQM manual. Beginning in September, providers will get reports on these events. To ensure the best possible reports, focus on accuracy in completing the related data elements. Investigate any emergent care events.

This is an excerpt from the article “OBQM Looks at Avoidable Instead of Adverse ” by Diane Omdahl, which originally appeared in the January  2010 edition of Homecare Direction. Learn more about Homecare Direction here!