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:

1. Administrative claims
2. Adverse event outcomes
3. Quality indicators
4. Disease-specific reports
5. OASIS-based quality improvement (OBQI) data
6. 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.

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

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.

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.