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Background: For home care agencies,
providing quality care requires having timely access to comprehensive
patient information. Managers need information to track patient outcomes,
home care use, satisfaction, and more. Quality improvement efforts rely on
such data to ascertain whether tested interventions have had their
intended effect. Home care agencies need a skilled clinical workforce to
collect this data and a sophisticated information system to aggregate it
and make it available in the form of useful reports.
Purpose: To create a
state-of-the-art, agency-wide system for the Visiting Nurse Service of New
York (VNSNY) for collecting and processing patient data, with the aim of
using it to improve quality of care and patient satisfaction.
Design: The VNSNY Outcomes
Initiative combines data collection activities, data analysis services for
patient managers, and a sophisticated, web-accessible patient information
database.
Data Collection
Through
educational sessions and newsletters, the VNSNY Outcomes Initiative
provides periodic training for VNSNY nurses to improve their data
collection skills. Initiative staff help nurses learn how to best
complete patient assessments using the Outcome and Assessment
Information Set (OASIS), a now-mandatory reporting tool that is used for
patient assessment, care planning, and quality assurance purposes. They
also provide training to help nurses collect accurate data on patient
utilization and satisfaction.
Data Analysis Services
Outcomes
Initiative staff provide VNSNY program managers and staff regular
reports about patient conditions, characteristics, outcomes, and more,
to help patient managers track trends and changes in their patients.
Using the Learning Collaborative model, a tested quality improvement
tool, staff members work with managers to use, understand, and interpret
patient data that they receive from the database.
Patient Information Database
The
Initiative undertook a major upgrade of the VNSNY patient information
database to accommodate expanded data collection efforts, including
OASIS and the Medicare Prospective Payment System, which began in
October 2000. As part of this effort, the Initiative utilizes data that
comes from a pen-based computer system, which allows nurses to enter
patient information at the bedside directly into the VNSNY database.
In 2002, the Initiative launched an intranet
website, which allows VNSNY staff to access the patient information
database and quickly create customized reports about patient
demographics, home care use, clinical characteristics, and satisfaction.
Information can be sorted by quarter, care program, borough, and team
number. Dozens of reports are now easily accessible.
Examples of the kinds of reports that are
available include:
- Administrative claims
- Adverse event outcomes
- Quality indicators
- Disease-specific reports
- OASIS-based quality improvement (OBQI) data
- Patient characteristics and service utilization
Initiative staff, based on usage of reports and
feedback from throughout the agency, continually expand the types of
reports that are available.
Here is an example of what a visitor would see
when accessing the intranet website home page:

Results: The VNSNY Outcomes
Initiative has enabled VNSNY to fully integrate data collection and
analysis with high-quality patient care. Accurate, timely, and
accessible information allows patient managers and clinicians to provide
optimal care and test and measure quality improvement interventions. A
unique capability in the home care field, the Initiative lays the
foundation for ongoing efforts to improve quality of care and patient
satisfaction.
Publications: Outcomes Initiative
News (distributed to VNSNY staff), intranet website, http://outcomes.vnsny.org/ (available to VNSNY staff).

Rosati, R.J.
2009
Evaluation of remote monitoring in
home health care. In: E.C. Conley, C.
Doarn & A. Hajjam-El-Hassani (Eds.)
Proceedings of the International
Conference on eHealth, Telemedicine and Social Medicine, eTELEMED 2009 (pp. 151
– 153). Los Alamitos, CA: IEEE Computer Society.
Rosati, R.J.
2009
History of quality measurement in home health care.
Clinics in Geriatric
Medicine. 25(1): 121-134.
Rosati, R.J.
2009
Home healthcare quality (guest editorial).
Journal for Healthcare Quality
(Special Issue: Home Healthcare Quality). 31(2): 3-4.
Rosati, R.J., Marren,
J.M., Davin, D.M., & Morgan, C.J. 2009
The linkage between employee and patient satisfaction in home health
care.
Journal for Healthcare Quality. 31(2): 44-53.

Ryvicker, M., Marren, J.,
Sobolewski, S., Acampora, T., Flannery, M., Buff, E., Hess, A.M., Rosati, R., Schwartz, T., & Feldman, P.H. 2008.
Spreading Improvement Strategies within
a Large Home Healthcare Organization.
Journal for Healthcare Quality.
30(2): 48-58.
Chaya, J., Reilly, M.,
Moriarity, M., Davin, D., Nero-Reid, V. & Rosenfeld, P. 2008
Preparing Newly Licensed Associate
Degree Nurses to Work in Home Health Care
Forthcoming in Home Health Care
Management & Practice.
Rosenfeld, P., Taylor,
E., Liu, C. & Volland, P. 2008
Articulating the Evidence Base for
Effective Social Work Practices with the Elderly: Building the Case for a
Geriatric Social Work Policy Agenda
Social Work and Public Health, v.23,
n.6: 23-38
Rosenfeld, P. & Adams,
R.E. 2008.
Factors Associated with Hospital
Retention of RNs in New York City
Metropolitan Area.
Policy, Politics, & Nursing
Practice,” 9 (3):158 - 172 .
Feldman,
P., Ryvicker, M., Rosati, R., Schwartz, T., Maduro, G.
2007.
HHA Partnering Collaborative Evaluation: Practice/Policy Brief.
Prepared for the Office of the Assistant Secretary for Planning and
Evaluation, U.S.
Department of Health and Human Services.
Available on the Web at:
http://aspe.hhs.gov/daltcp/reports/2007/HHAPartrb.htm
Lawrence, F.P.,
Damron-Rodriquez, J., Rosenfeld, P., Sisco, S., & Volland, P.J.
2007.
Strengthening field education in aging through university-community agency
partnership: The Practicum Partnership Program.
Journal of Gerontological Social Work, 501(1-2): 135-154.
Rosati,
R.J., & Huang, L. 2007.
Development and testing of an analytic model to identify home healthcare
patients at risk for a hospitalization within the first 60 days of care.
Home Health Care Quarterly Services. 26(4): 21-36.
Siegler,
E., Murtaugh, C., Rosati, R., Schwartz, T., Razzano, R.,
Sobolewski, S., & Callahan, M. 2007.
Improving communication at the transition to home health care: Use of an
electronic referral system.
Home Health Care Management and Practice. 19(4): 267-271.
Rosenfeld,
P. 2007.
Measurement (definition). Encyclopedia of Elder Care (2nd Ed.)
New York, NY:
Springer Publishing Company
Rosenfeld,
P. 2007.
Workplace practices for retaining older nurses: Implications from a study of
nurses with eldercare responsibilities.
Policy, Politics and Nursing Practice. 8(2): 120-129.
Rosenfeld,
P., Dennis, J., Hanen, S., Henriquez, E., Schwartz, T.,
Correoso, L., Murtaugh, C., & Fleishman, A. 2007.
Are there racial differences in attitudes towards hospice care: A study of
hospice-eligible patients at Visiting Nurse Service of New York.
American Journal of Hospice and Palliative Care. 24(5): 408-416.
Weiss,
L., Gany, F., Rosenfeld, P., Carrasquillo, O., Sharif, I.,
Behar, E., Ambizas, E., Patel, P., Schwartz, L., & Mangione, L. 2007.
Access to multilingual medication instructions at New York City pharmacies.
Journal of Urban Health. 84(6): 742-754.

Feldman, P.H.,
McDonald, M., Rosati, R., Murtaugh, C., Kovner, C.T.,
Goldberg, J.D. &
King, L. 2006.
Exploring the potential utility of
automated drug alerts in home health
care.
Journal of Healthcare Quality 28(1):29-40.
Rosati, R.J.
2006.
Focusing
on home healthcare quality (Guest Editorial).
Journal for Healthcare Quality (Special
Issue: Home Healthcare Quality).
28(1):2, 55.
Siegler,
E.J., Murtaugh,
C.M., Rosati, R.J., Clark,
A., Ruchlin,
H., Sobolewski, S., Feldman, P.H., & Callahan, M. 2006.
Improving the transition to home
healthcare by rethinking the purpose
and structure of the CMS 485: First steps.
Home Healthcare Services
Quarterly. 25(3-4): 27-38.

Byers,
J.F., & Rosati, R.J. 2005.
Module One: "Foundation, Techniques and
Tools" In: L.R.
Pelletier & C.L. Beaudin (Eds.), Q solutions: Essential
resources for the
healthcare quality professions.
Glenview,
IL:
National Association for
Healthcare Quality. 27(4)
Byers,
J.F., & Rosati, R.J. 2005.
Research
provides the MEAT for quality improvement (Guest Editorial).
Journal for Healthcare Quality (Special
Issue: Healthcare Quality
Research).
Neder,
S., Rosati,
R.J., & Huang, L. 2005.
Assessment
of OASIS inter-rater reliability and validity using several
methodological
approaches.
Home Healthcare Services Quarterly.
24(3):23-38.

Keepnews,
D., Capitman, J.A., & Rosati, R.J. 2004.
Measuring
patient-level clinical outcomes of home health care.
Journal of Nursing Scholarship. 36(1):
79-85.

Rosati, R.J., Huang, L., Navaie-Waliser,
M., & Feldman, P.H. 2003.
Risk factors for repeated
hospitalizations among home health care recipients. Journal for Healthcare Quality, 25,
4-11.
Rosati, R.J. 2003. Creating quality improvement
projects. In: Siegler, E.L., Mirafzali, S., and Foust, J.B. (eds.) A
Guide to Hospitals and Inpatient Care. New York: Springer Publishing
Company.
Siegler, E.L., Del Monte, M.L., & Rosati, R.J.
2002. What role should the nephrologist play in the provision of
palliative care? Journal of Palliative Medicine, 5, 759-763.
Sponsor: Visiting Nurse Service of
New York
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