OASIS Alert

OK, so the last time you kept a journal, your older brother broke the lock and read it over your high school’s PA system. Still, that’s no reason to completely dismiss the idea of maintaining an “OBQI journal” — especially when it can help improve patient outcomes for your home health agency.

Given the outcome-based quality improvement program’s relatively recent prominence on the home care scene, Chapter 7 of the OBQI Implementation Manual suggests “it  may be beneficial for agencies to maintain an informal log or journal throughout the outcome enhancement activities.”

Keeping such a journal “may facilitate recall and reflection in the future,” as it would allow HHAs to document how they chose team members to participate, how they  prioritized outcomes, and how they selected best practices, the manual reports.

Maintaining an OBQI journal “would be very helpful during a survey” now that the survey process includes an emphasis on OBQI data, says Cyndi Rohret, a clinical consultant with Briggs Corp. in West Des Moines, IA.

Under the new survey protocol released late last year, CMS has instructed surveyors to consider a list of 10 OBQI outcomes during the pre-survey process (see OASIS Alert,  Vol. 3, No. 11, p. 112).

An OBQI journal can help HHAs prepare for potential surveyor visits since it’s “a proactive recommendation” and not something that needs to be submitted, notes consultant  Pam Warmack, with Ruston, LA-based Clinic Connections. By creating a “tracking document that you can record in on an ongoing basis,” an HHA can readily identify and  follow those areas of improvement or stabilization for which its performance is below the national average, she advises.

“It’s something that an agency can do to steer or help to change its outcomes as patient care is actually in process,” rather than simply waiting to identify the problems  afterward, recommends Warmack.

So what information goes into an OBQI journal? For starters, agencies might want to document how they decided which outcomes to target for investigation, suggests Kathy  Green, vice president of clinical advisement at Tampa, FL-based HQS (formerly Provider Solutions). HHAs could include such items as committee meeting notes or  comments from the staff that reveal the agency’s decision-making processes.

“There’d be something in there that showed what they did [to decide], instead of just an edict from the Quality Assurance nurse saying, ‘We’re going to have these two target  outcomes,’” Green tells Eli. If your agency or a state surveyor later determines that your selected outcomes were inappropriate, then you can go back to your journal and review the steps that led to their selection, she states.

After choosing target outcomes, agencies can use their OBQI journals to document all of the steps they are taking to improve in those areas, Rohret informs agencies. The  journal should also track those staff members who are responsible for or who will be impacted by the agency’s improvement plan. HHAs should then “monitor the changes in the outcome over time, such as each quarter,” and record any modifications they make to their plan, she directs.

Usually, an agency’s Quality Assurance nurse would be responsible for maintaining an OBQI journal, explains Green. Additionally, suggests Warmack, an agency could train  data entry specialists to “document the pre-identified criteria that impact targeted outcomes” as they’re inputting information into the agency’s computers. These individuals  could place the information into a journal so that “someone from clinical management would analyze the data and convert it into a plan of action,” she says.

While keeping an OBQI journal might mean a considerable amount of manpower for some HHAs, Warmack nonetheless recommends the journal process to agencies  looking to get a leg up on their next batch of outcome reports.