Outcome-Based Quality Improvement (OBQI)

1 Outcome-Based Quality Improvement ( obqi ) manual Revised: August 2010 Centers for Medicare & Medicaid Services obqi Implementation manual August 2010 i Centers for Medicare & Medicaid Services Table of Contents Chapter Page 1. Introduction .. A. Understanding B Outcome-Based Quality Improvement ( obqi ) in Context .. C. Overview of This Table : Location of Learning Activities and Agency Strategies for outcome Enhancement Steps .. D. What This manual Is and What It Is E. Benefits of Implementing 2.

2 Outcomes and obqi .. A. What Is So Important About Outcomes? .. B. What Is obqi ? .. Figure : Two-Stage obqi Framework .. C. Reports To Be Used for outcome Enhancement .. Figure : Excerpt outcome Report .. Table : OASIS- based outcome Measures .. Table : Excerpt Agency Patient-Related Characteristics Report .. Figure : Excerpt Potentially Avoidable Event Report .. Figure : Excerpt Process Quality Measure D. Moving Toward outcome Management .. Figure : The outcome Model.

3 Frequently Asked Questions .. 3. Interpreting outcome Reports .. A. Introduction .. B. Data Analysis .. C. Reports Produced from OASIS Data .. D. Reviewing and Interpreting outcome Reports .. Figure : Illustrative Page from Sample All Patients Risk Adjusted outcome Report .. E. Risk Adjustment .. Table : Steps in Risk Adjustment .. F. Data Shock .. G. Presenting the outcome Report to Staff .. H. Report I.

4 Summary .. Frequently Asked Questions .. Attachment A: Illustrative outcome Report for Faircare Home Health Services .. Attachment B: Exercises in Interpreting outcome Reports .. Attachment C: Overview of Risk Adjustment Methodology Used for Home Health Agency obqi Reports .. Attachment D: Agency Strategies to Facilitate Interpreting outcome Reports .. Table of Contents (Continued) Chapter Page obqi Implementation manual August 2010 ii Centers for Medicare & Medicaid Services 4.

5 Selecting Target Outcomes .. A. Introduction .. B. Selecting Outcomes for Further Investigation .. C. Using the Agency-Patient Related Characteristics Report to Assist in Target outcome Selection .. D. Who in the Agency Should Select the Target Outcomes? .. E. Timeline for Selecting Target Outcomes .. F. Summary .. Frequently Asked Questions .. Attachment A: Exercises in Selecting Target Outcomes .. Attachment B: Worksheet: Selecting Target Outcomes .. Attachment C: Agency Strategies to Facilitate Selecting Target Outcomes.

6 5. Conducting the Process-of-Care Investigation .. A. Introduction .. B. What Is the Process of Care Investigation? .. C. Benefits of the Process of Care Investigation .. D. Pitfalls to Avoid .. E. Planning the Investigation .. F. Identifying What Should Be Done in Providing Care .. G. Conducting the Investigation .. H. Selecting Cases for Review of Care Provided .. Figure : Excerpt Faircare Home Health Services Agency Patient-Related Characteristics and outcome Tally Reports.

7 Figure : Excerpt Faircare Home Health Services All Patients Risk Adjusted outcome Report .. 5-11 I. Drawing Conclusions .. J. Timeline for Completing the Process of Care Investigation .. Frequently Asked Questions .. Attachment A: Steps in Conducting a Focused Record Review .. Attachment B: Tools to Implement Quality Improvement .. Attachment C: Exercises in Investigating Important Clinical Attachment D: Agency Strategies to Facilitate Investigating Care Processes.

8 Table of Contents (Continued) Chapter Page obqi Implementation manual August 2010 iii Centers for Medicare & Medicaid Services 6. Developing the Plan of Action .. A. Introduction .. B. What is the Plan of Action? .. Figure : Sample Plan of Action for the Target outcome of Improvement in Toilet Transferring .. C. Who Develops the Plan of Action? .. D. Statements of Problem/Strength in Care Provision .. E. Statements of Best Practices .. F. Timeline for Developing the Plan of Action.

9 Frequently Asked Questions .. Attachment A: Plan of Action for Quality Improvement Form .. Attachment B: Exercises in Evaluating Problem Statements and Best Practices .. Attachment C: Agency Strategies for Developing Statements of Problem or Strength in Care Provision .. Attachment D: Agency Strategies for Developing Statements of Best Practices .. 7. Implementing and Monitoring the Plan of Action .. A. Introduction .. B. Fostering Behavioral Change in Care Delivery .. C.

10 Planning the Implementation of the Action Plan .. D. Approaches to Change Clinical Practice .. E. Monitoring the Plan of Action .. F. Evaluating the Plan of Action .. G. Documenting the Quality Improvement Journey .. H. Summary .. Frequently Asked Questions .. Attachment A: Sample Action Strategies .. Attachment B: Exercises in Evaluating Action Attachment C: Broaden Your Options: Techniques to Foster Clinical Behavior Change .. Attachment D: Sample Monitoring Attachment E: Checklists for Your Agency's Plan of Action.