Putting the PI in QAPI: Performance Improvement in Home Health

As home health agencies face increased pressure to move toward value-based delivery models, developing, implementing, and maintaining an effective QAPI program is essential to ensure success with the quadruple aim. Yet while many agencies have a pulse on their outcomes, they often encounter difficulty in implementing targeted performance improvement projects.

To create an effective performance improvement plan, it’s important to focus holistically on educating and engaging both clinicians and patients using strategies targeted at the quality measures you’d like to improve. In this article, we’ll walk through four areas that frequently appear on payer scorecards and give recommendations for improving your outcomes in these areas.

Timely Initiation of Care

One of the most important process measures for agencies is timely initiation of care. Because the risk of readmission is highest in the first seven days (and especially in the first two), agencies are penalized if they don’t make an initial visit to the patient’s home within the first 48 hours.

How to improve your metrics

Strategies focused on clinicians: If your score in this area isn’t optimal, start by improving your process for getting clinicians in the home quickly. Help your clinicians understand the importance of prioritizing visits for new patients and work with them on adjusting their schedules so that they visit new patients in the mornings instead of in the afternoons.

You’ll also want to evaluate your OASIS accuracy, as documentation errors can inadvertently leave your agency without credit for having initiated care within the proper window. Ensuring accuracy around the entry of OASIS items such as M0104 can make an immediate impact on timely initiation scores.

Strategies focused on patients: Start off on the right foot with patients who might prefer not to have visitors early in the day by ensuring that your clinicians are able to communicate clearly and sensitively why this is necessary.

Quality Measures

Quality measures assess patient improvement over time, from the point at which the clinician initially enters the home to the point of discharge. Payers look at OASIS data to determine whether patients demonstrate improvement in specific clinical areas such as ambulation, transfers, and the ability to effectively self-manage their condition.

How to improve your metrics

Strategies focused on clinicians: According to the World Health Organization (WHO), outcomes for patients with chronic conditions are significantly higher when patients (and their families) take an active role in their care.

Educate your clinicians on using a phased approach to help patients self-manage or co-manage their condition. For example, during an initial visit to a patient with congestive heart failure, a clinician might assess the patient’s level of knowledge of their condition, then progressively build on that knowledge with targeted information about diet, exercise, and when to call a particular care provider.

Also ensure that your clinicians are performing accurate documentation using OASIS in order to demonstrate the right level of patient progress to payers.

Strategies focused on patients: The key to helping patients improve in the areas mentioned above is to provide them with the education and engagement they need to better manage their condition and navigate daily activities. Help patients adhere to their treatment plan and improve functional independence by supplementing in-person visits with video-based exercises and education, virtual visits, and clinician messaging.

Reported Occurrences

After patients transition to the home environment, they might initially have an increased risk for avoidable incidents that result in hospitalization, raise the overall cost of care, and negatively impact the patient. Common reported occurrences include falls, medication errors, or a medical issue.

How to improve your metrics

Strategies focused on clinicians: First, identify the type of reported occurrences that occur most frequently, such as patient falls, and then train staff in key strategies for preventing those events using evidence-based education.

Strategies focused on patients: Patients often face a steep learning curve in navigating the activities of daily living after leaving the hospital where all care is provided for them. Deliver education and exercises targeted at helping patients reduce the risk of the negative events you’ve identified.

Patient satisfaction

Patient satisfaction is driven by the patient experience and how patients and caregivers perceive the delivered care. To measure patient satisfaction at a particular agency, payers look at results from the HHCAHPS survey, including NPS® scores, which rate how likely patients are to recommend the agency to someone else.

A summary of the agency’s performance on the HHCAHPS survey, which is completed by patients after discharge from home health, is publicly reported by CMS and often evaluated by other payers.

How to improve your metrics

Strategies focused on clinicians: Train your staff on how to deliver patient-centered care based on principles of compassionate care, collaborative involvement between patients and families, and attention to health literacy, language, and culture. Clear communication and compassionate care helps patients better understand how to manage their condition and improves their overall experience of care, leading to higher satisfaction.

Strategies focused on patients: If your patient satisfaction scores are too low, attending to the three categories mentioned above should help to raise them by increasing quality of care and patient outcomes, which are also strongly correlated with patient satisfaction.1

In particular, be sure to equip your patients with the tools they need to understand their condition and treatment plan. By enhancing patient self-efficacy, you can also improve patient activation, adherence, and satisfaction.

How MedBridge Can Help Your Agency Improve QAPI Measures

MedBridge allows agencies to easily implement a patient-centric care model that improves quality of care. To enhance operational excellence, the patient experience, and QAPI measures, home health agencies are partnering with MedBridge to deploy powerful patient education and clinician training while integrating patient management and engagement tools like virtual visits, clinician messaging, and gamification into care plans.

We offer education and training on:

and much more.

  1. Glickman, S. W., Boulding, W., Manary, M., Staelin, R., Roe, M. T., Wolosin, R. J., & Ohman, E. M., et al. (2010). Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circulation. Cardiovascular Quality and Outcomes, 3(2), 188–95.