SHOW ME: enhancing OASIS functional assessment.

Have you ever felt that the search for Outcome and Assessment Information Set (OASIS) accuracy is endless? In 2007, the administrators and clinical managers at Professional Healthcare Resources, Inc. (PHRI) looked at the agency’s functional outcome indicators (improvement in bathing, transferring, ambulation/locomotion, and management of medications) and shook our heads. Once again, the outcomes did not seem to capture our intuitive sense of the degree to which our patients actually did functionally improve under our care. Why were these outcomes not better? Our home health agency has 8 offices in the Maryland, Virginia, and the metro DC area. Each week, our administrators and clinical managers meet to discuss quality issues via a conference call. As we reviewed the most recent Home Health Compare outcomes for each office, we considered possible causes for outcome reports that did not match clinicians’ reports of patient progress. The clinical managers of PHRI review their teams’ patient outcomes at discharge. When patients do not improve, the managers frequently discuss the outcomes with the clithan a therapist would at admission. Nurses tend to overestimate patients’ functional abilities at admission, whereas therapists seem to capture the patient’s functional status adequately at discharge. This interrater variability leads to an erroneous “no improvement” when patients’ functional abilities actually have improved significantly.