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Standardized Data:
The Foundation for Home Care Report Cards

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 ability to aggregate data to create useful information. What data are needed in home care? When reviewing many health care journals, it is evident that comprehensive clinical and financial data are needed to effectively manage in today's environment. Not only are data needed to make management decisions, but also to meet reimbursement and regulatory requirements. Home care traditionally has documented care according to reimbursement and regulatory requirements. However, new requirements are emerging. These demands are related to the concern about the high cost of health care and how to demonstrate more efficient care while having the highest quality care. Two such trends influencing data collection include consumer report cards and managed care.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which not only accredits hospitals, but also home care, has issued the first "mandatory" report card. Report cards are public reports comparing quality for an organization with other organizations in an industry. The JCAHO report card focuses on hospitals at this time, but home care providers can anticipate that this activity will spread to home care. In fact, HCFA is moving toward report cards for organizations who receive Medicare and Medicaid. The quality indicators developed by Shaughnessy's research team to measure outcomes in home care will be included in the Medicare survey process, and most likely will form the basis for home care consumer report cards.

Managed care has been the driving force behind the development of consumer report cards. Purchasers and individual consumers want to know about the quality of care they can expect when buying health care or selecting a provider. When consumers buy any other product, they want to know what to expect in return for the money spent. It is unimaginable that consumers would buy a washer, car, or house without asking about the quality of the product. Other than word of mouth, consumers and purchasers have not had information available to judge the quality of health care. Report cards will provide at least some information for comparison shopping.

Home care providers must be alert to whether data which will be used to describe the quality of their care is reliable and valid. Providers also will need to analyze the specific care provided by staff to determine if it contributes to quality care. Home care is primarily provided by or directed by nursing. Without standardization of nursing data, home care providers will not be able to analyze data across clients to determine what interventions make a difference nor what outcomes are produced. In a recent report, "Nursing Report Card for Acute Care Settings," the American Nurses' Association states that there are many inputs which influence outcomes, one of which is nursing. Nursing inputs include: health status assessment, surveillance, symptom control, infection control, physical safety, nutrition/hydration, therapeutic procedures, patient education/counseling, and discharge planning. The way in which nursing data can be standardized to capture this information 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 everyday 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 producing consumer report cards, 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). Standardized Data: The Foundation for Home Care Report Cards. The Quality Messenger, 1(3), 5, 7, 8.

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