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The Need For Standardized Data in Home Health Care

By Bonnie Westra, PhD, RN

Alvin Toffler, in his book The Third Wave (1980), predicted that we were moving from the industrial to the information age. Key to flourishing in the information age is the incorporation of standardized data within integrated computer systems. This is particularly evident in federal and state health care reform. According to Clinton's Health Security Plan, standardized data collected across health care settings are needed to measure outcomes and provide consumers with information regarding quality and costs of health plans. The Health Care Financing Administration's (HCFA) Section of Survey and Compliance is moving toward the development of standardized data collection instruments which are patient-centered and useful for continuous improvement.

The call for integrated state-wide data is evident in such states as Minnesota, Iowa, and Florida. For instance, in Minnesota the Minnesota Health Data Institute (MHDI) was initiated as part of health care reform to collect standardized data which are valid and reliable for holding health plans and providers accountable regarding a) cost, b) access, and c) quality. In the first year data collection will focus on hospitals and health plan enrollees. Beginning in the second year, the MHDI will begin to collect data in other health care settings which may include home care. Similar to Iowa, the MHDI will examine the usefulness of the Nursing Minimum Data Set, which includes the variables of nursing diagnosis, nursing interventions, and nursing sensitive outcomes.

Since nursing is the largest health care provider, the use of large integrated data systems are invalid without nursing data. The way in which we can standardize nursing data is to use the recommended classification systems. The American Nurses Association has recommended four classification systems for standardizing nursing data. These are: the North American Nursing Diagnosis Association (NANDA) nursing diagnoses; the Omaha System which includes nursing diagnoses, interventions, and outcome ratings; the Nursing Intervention Classification (NIC) system of interventions; and the Home Health Care Classification System which includes nursing diagnoses and interventions. Of these systems, the Omaha System was developed for use in community/home health and is the most comprehensive and well tested. it is based on language of practicing nurses and has been developed over 15 years through federally funded studies.

The most feasible way to collect standardized data is to build data collection into every day practice through the use of computerized documentation systems. In that way, data need only be entered once and then is available for multiple purposes, such as continuous improvement, research, and transmission for inclusion in large integrated health data systems. This is only possible, however, if the documentation program allows for retrieval and ready manipulation of data to respond to changing information needs. CareFacts by Epsilon Systems, Inc. is such a system. Through incorporation of the Omaha System into home care documentation and inclusion of querying functions, the CareFacts program provides a powerful solution to home health agencies' ability to capture and use information in a cost-effective manner.

Citation: Westra, B. (1994). The Need for Standardized Data in Home Care. The Quality Messenger, 1(2), 5.

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