National Voluntary Consensus Standards for Home Health Care...relevant in healthcare today. More...

A CONSENSUS

REPORT

NAT I O N A L QU A L I T Y FO R U M

National Voluntary

Consensus Standards

for Home

Health Care

Foreword

NATIONAL QUALITY FORUM

The old saying that “there is no place like home” is increasinglyrelevant in healthcare today. More than 4 million patients currently

receive home health services, and the number is steadily increasing.Despite the growing popularity of home care, information to assistpatients and their families in assessing the quality of home careproviders is scant.

This report details 15 standardized performance measures that will facilitate the comparison of the quality of home health careproviders. These measures have been carefully reviewed andendorsed by a diverse group of stakeholders pursuant to the NationalQuality Forum’s (NQF’s) formal Consensus Development Process, giving them the special status of voluntary consensus standards.

The primary purpose of these NQF-endorsedTM voluntary consensusstandards is to help consumers select high-quality home health careproviders. The Centers for Medicare and Medicaid Services will reportdata from these measures for all Medicare-certified home health agencies on its web site, Home Health Compare (www.medicare.gov/HHCompare). The consensus standards also may be used by homehealth care providers for internal quality improvement efforts and bypurchasers, policymakers, researchers, and regulators for their variouspurposes.

We thank the Home Health Care Performance Measures SteeringCommittee and its Technical Advisory Panel, as well as the NQFMember organizations, for their assistance with this project and fortheir collective dedication to improving the quality of home health care.

Kenneth W. Kizer, MD, MPHPresident and Chief Executive Officer

© 2005 by the National Quality Forum All rights reserved

Printed in the U.S.A.

No part of this may be reproduced, stored in a retrieval system, or transmitted, in any form or by anymeans electronic, mechanical, photocopying, recording, or otherwise, without prior written permissionof the National Quality Forum. Requests for permission to reprint or make copies should be directed to:

PermissionsNational Quality Forum

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Fax 202.783.3434www.qualityforum.org

National Voluntary Consensus Standards for Home Health Care


Table of ContentsExecutive Summary................................................................................................................... vIntroduction ................................................................................................................................ 1National Voluntary Consensus Standards for Home Health Care.................................... 2Relationship to Other NQF-EndorsedTM Consensus Standards ......................................... 3Identifying the Set...................................................................................................................... 4

Definition of Home Health Care........................................................................................ 4Purpose................................................................................................................................... 5Framework for Measurement............................................................................................. 6Scope....................................................................................................................................... 7Priority Areas for Measurement ........................................................................................ 7Criteria for Selection of Consensus Standards ................................................................ 8Box A. Criteria for Evaluation and Selection................................................................... 9

The NQF-Endorsed Consensus Standards ............................................................................ 8Research ..................................................................................................................................... 11

Measures that Address All Home Health Care Populations ...................................... 11Cross-Cutting Measures .................................................................................................... 11Measures that Address All Home Health Care Provider Organizations ..................... 11Measures that Address All of the NQF Aims ................................................................ 11Measures in All Framework Areas .................................................................................. 11Measures that Address High-Risk, High-Volume, High-Cost

Conditions and Treatments............................................................................................ 12Care Management and System-Level Coordination Measures .................................. 12Measures for Which Gaps in Consensus Exist .............................................................. 12Box B. Specific Priorities for Research ............................................................................ 13

Additional Recommendations ................................................................................................12Data and Burden Reduction ............................................................................................. 12Information System Readiness......................................................................................... 12Sufficiency of Measures Against Evaluation Criteria................................................... 12Equitable Home Health Care Quality............................................................................. 15Implementation................................................................................................................... 15Reporting Home Health Care Performance................................................................... 15Scope of the Consensus Standards .................................................................................. 15Improving the Set ............................................................................................................... 15

Acknowledgments ................................................................................................................... 15Table 1: National Voluntary Consensus Standards for Home Health Care ................... 16

III

IV NATIONAL QUALITY FORUM

(continued)

Appendix A — Specifications of the National Voluntary Consensus Standards for Home Health Care .............. A-1

Appendix B — Members and Board of Directors ............................................................................................................. B -1

Appendix C — Steering Committee and Project Staff ..................................................................................................... C-1

Appendix D — Commentary ................................................................................................................................................ D-1

Appendix E — Acronyms and Glossary ............................................................................................................................ E -1

Appendix F — Selected References..................................................................................................................................... F -1

Appendix G — Consensus Development Process: Summary ......................................................................................... G-1

National Voluntary Consensus Standards for Home Health Care


Executive Summary

The quality of home health care—defined as any healthcare servicesprovided to clients in their homes, including but not limited to

skilled nursing services, home health aide services, palliative and end-of-life care (e.g., in-home hospice services), therapies (i.e., physical,speech-language, and occupational), homemaker services/personalcare, social services, infusion and pharmacy services, medical suppliesand equipment, and in-home physician services—is a subject of grow-ing national concern. Although more than 4 million patients receivecare from approximately 20,000 home health agencies, of which nearly7,000 are Medicare certified, limited information is available to supportquality-based decisions by patients and their families.

Publicly reported measures of performance that allow comparisonsamong providers have been reported by the Centers for Medicare and Medicaid Services (CMS) for home health care since 2003, when the federal government launched its Home Health Quality Initia-tive (www.medicare.gov/HHCompare). However, information to begleaned from this initiative was limited, and consensus among con-sumers, providers, purchasers, researchers, and quality improvementorganizations on these measures had not been achieved. To ensure thatthose stakeholders had the opportunity to provide their input, CMSasked the National Quality Forum (NQF) to identify a set of voluntaryconsensus standards for home health care. Based on its review of avail-able measures, NQF has endorsed a set of 15 performance measures, 8 research recommendations, and 8 additional recommendations.

V

VI NATIONAL QUALITY FORUM

The primary purpose of these homehealth care voluntary consensus standardsis to provide information to help consumersselect home health care providers. Thestandards are intended to emphasize careprovided by the range of personnel pro-viding home health care services, as well as the variety of provider organizationsdelivering home-based care. However,given the paucity of measures in certainareas, these consensus standards are an initial set that collectively only begins toaddress the quality of home health careservices in the United States. Today, CMS is collecting and publicly reporting infor-mation on the quality of home health careproviders as part of the Home HealthQuality Initiative, which is based on theNQF-endorsedTM consensus standards.

National Voluntary ConsensusStandards for Home Health Care■ Improvement in ambulation/locomotion■ Improvement in bathing■ Improvement in transferring■ Improvement in management of oral

medications■ Improvement in pain interfering with

activity■ Improvement in status of surgical

wounds■ Improvement in dyspnea■ Improvement in urinary incontinence■ Increase in number of pressure ulcers■ Emergent care for wound infections,

deteriorating wound status■ Emergent care for improper medication

administration, medication side effects■ Emergent care for hypo/hyperglycemia■ Acute care hospitalization■ Discharge to community■ Emergent care

Appendix A

Specifications of the National Voluntary Consensus Standards forHome Health Care


The following table summarizes the detailed specifications for eachof the National Quality Forum (NQF)-endorsedTM home health care

performance measures. All information presented has been deriveddirectly from measure sources/developers without modification oralteration (except when the measure developer agreed to such modifi-cation during the NQF Consensus Development Process) and is currentas of September 1, 2005.

All NQF-endorsed voluntary consensus standards are open source,meaning they are fully accessible and disclosed. References to relatedrisk-adjustment methodologies and definitions are provided to assureopenness and transparency.

Issues regarding any NQF-endorsed consensus standard (e.g., modifi-cations to specifications, emerging evidence) may be submitted to NQFfor review and consideration via the “Implementation Feedback Form”found at www.qualityforum.org/implementation_feedback.htm. NQFwill transmit this information to the measure developers and/or compileit for consideration in updating the measure set.

A-1

A-2

Appe

ndix

A –

Spe

cific

atio

ns o

f the

Nat

iona

l Vol

unta

ry C

onse

nsus

Sta

ndar

ds fo

r Hom

e He

alth

Car

e

Fram

ewor

k Ca

tego

ryM

easu

reSo

urce

of M

easu

reNu

mer

ator

Deno

min

ator

Exclu

sions

Func

tiona

l act

iviti

es

of d

aily

livi

ng (A

DLs)

1.Im

prov

emen

tin

ambu

latio

n/lo

com

otio

n1

2.Im

prov

emen

tin

bat

hing

1

Outco

me a

ndAs

sess

men

tIn

form

atio

n Se

t(O

ASIS

)/Out

com

e-Ba

sed

Quali

tyIm

prov

emen

t(O

BQI)2,

3,4

OASI

S/OB

QI2,

3,4

Patie

nts f

or w

hom

the

valu

e of O

ASIS

item

M07

00Am

bulat

ion/

Loco

mot

ion

(asc

ale ra

ngin

g fro

m 0

to 5

) at

disc

harg

e fro

m h

ome h

ealth

care

is lo

wer n

umer

ically

(in

dica

ting

less i

mpa

irmen

t)th

an th

e valu

e of t

he sa

me

item

at th

e sta

rt of

or

resu

mpt

ion

of ca

re

Patie

nts f

or w

hom

the v

alue

of O

ASIS

item

M06

70 B

athi

ng(a

scale

rang

ing

from

0 to

5)

at d

ischa

rge f

rom

hom

e hea

lthca

re is

lowe

r num

erica

lly

(indi

catin

g les

s im

pairm

ent)

than

the v

alue o

f the

sam

eite

m at

the s

tart

of or

re

sum

ptio

n of

care

Patie

nts f

or w

hom

the v

alue o

f the

OAS

ISite

m M

0700

Am

bulat

ion/

Loco

mot

ion

at

the s

tart

of or

resu

mpt

ion

of ca

re is

>0

(i.e.,

it is

poss

ible

for i

mpr

ovem

ent t

o occ

ur)

Patie

nts f

or w

hom

the v

alue o

f the

OAS

ISite

m M

0670

Bat

hing

at th

e sta

rt of

orre

sum

ptio

n of

care

is >

0 (i.

e.,it

is po

ssib

lefo

r im

prov

emen

t to o

ccur

)

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re

■Ep

isode

s of h

ome h

ealth

care

endi

ng w

ith

adm

issio

n to

an in

patie

nt fa

cility

or d

eath

■M

ater

nity

pat

ients

■<

18 ye

ars o

f age

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

ad

miss

ion

to an

inpa

tient

facil

ity or

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

1R

isk

adju

sted

with

the

logi

stic

reg

ress

ion

mod

el d

escr

ibed

in S

haug

hnes

sy P

W, H

ittle

DF,

Ove

rvie

w o

f Ris

k A

djus

tmen

t and

Out

com

e M

easu

res

for

Hom

e H

ealth

Age

ncy

OBQ

I Rep

orts

: Hig

hlig

hts

ofC

urre

nt A

ppro

ache

s an

d O

utlin

e of

Pla

nned

Enh

ance

men

ts,B

altim

ore,

MD

: Cen

ters

for

Med

icar

e an

d M

edic

aid

Serv

ices

(CM

S); S

epte

mbe

r 20

02. A

vaila

ble

atw

ww

.cm

s.hh

s.go

v/oa

sis/

Ris

kAdj

1.pd

f. La

st a

cces

sed

Aug

ust 3

, 200

4.2

All

Out

com

e-Ba

sed

Qua

lity

Impr

ovem

ent (

OBQ

I) a

nd O

utco

me-

Base

d Q

ualit

y M

onito

ring

(OBQ

M) m

easu

res

are

deri

ved

from

the

OA

SIS

data

sets

. Ava

ilabl

e at

:w

ww

.cm

s.hh

s.go

v/oa

sis/

oasi

sdat

.asp

. Las

t acc

esse

d A

ugus

t 2, 2

004.

3Fo

r al

l OBQ

I and

OBQ

M m

easu

res,

tran

sfor

mat

ion

docu

men

tatio

n is

pro

vide

d in

app

endi

x A

, tab

le 1

.4

Mea

sure

s de

rive

d fr

om O

ASI

S (i.

e., O

BQIs

and

OBQ

Ms)

app

ly to

“ad

ult p

atie

nts

rece

ivin

g ho

me

heal

th s

kille

d se

rvic

es”

(see

ww

w.c

ms.

hhs.

gov/

oasi

s/hh

regs

.asp

) as

a su

bset

of t

he b

road

erde

finiti

on o

f hom

e he

alth

car

e ad

opte

d fo

r th

ese

natio

nal v

olun

tary

con

sens

us s

tand

ards

.

A-3

Appe

ndix

A –

Spe

cific

atio

ns o

f the

Nat

iona

l Vol

unta

ry C

onse

nsus

Sta

ndar

ds fo

r Hom

e He

alth

Car

e (c

ontin

ued)

Fram

ewor

k Ca

tego

ryM

easu

reSo

urce

of M

easu

reNu

mer

ator

Deno

min

ator

Exclu

sions

Func

tiona

l act

iviti

es

of d

aily

livi

ng (A

DLs)

cont

inue

d

Func

tiona

l in

stru

men

tal a

ctiv

ities

of d

aily

livi

ng (I

ADLs

)

Phys

iolo

gic

3.Im

prov

emen

tin

tran

sferri

ng1

4.Im

prov

emen

tin

man

age-

men

t of o

ral

med

icatio

ns1

5.Im

prov

emen

tin

pain

in

terfe

ring

with

activ

ity5

OASI

S/OB

QI2,

3,4

OASI

S/OB

QI2,

3,4

OASI

S/OB

QI2,

3,4

Patie

nts f

or w

hom

the v

alue o

fOA

SIS i

tem

M06

90 Tr

ansfe

rring

(a sc

ale ra

ngin

g fro

m 0

to 5

) at

disc

harg

e fro

m h

ome h

ealth

care

is lo

wer n

umer

ically

(in

dica

ting

less i

mpa

irmen

t)th

an th

e valu

e of t

he sa

me

item

at th

e sta

rt of

or

resu

mpt

ion

of ca

re

Patie

nts f

or w

hom

the

valu

e of O

ASIS

item

M07

80M

anag

emen

t of O

ral

Med

icatio

ns (a

scale

rang

ing

from

0 to

2) a

t disc

harg

e fro

mho

me h

ealth

care

is lo

wer

num

erica

lly (i

ndica

ting

less

impa

irmen

t) th

an th

e valu

e of

the s

ame i

tem

at th

e sta

rt of

or re

sum

ptio

n of

care

Patie

nts f

or w

hom

the v

alue o

fOA

SIS i

tem

M04

20 Fr

eque

ncy

of Pa

in (a

scale

rang

ing

from

0

to 3

) at d

ischa

rge f

rom

ho

me h

ealth

care

is lo

wer

num

erica

lly (i

ndica

ting

less

impa

irmen

t) th

an th

e valu

e of

the s

ame i

tem

at th

e sta

rt of

or re

sum

ptio

n of

care

Patie

nts f

or w

hom

the v

alue o

f the

OAS

ISite

m M

0690

Tran

sferri

ng at

the s

tart

orre

sum

ptio

n of

care

is >

0 (i.

e.,it

is po

ssib

lefo

r im

prov

emen

t to o

ccur

)

Patie

nts f

or w

hom

the v

alue o

f the

OA

SIS i

tem

M07

80 M

anag

emen

t of O

ral

Med

icatio

ns at

the s

tart

of or

resu

mpt

ion

of ca

re is

>0

(i.e.,

it is

poss

ible

for

impr

ovem

ent t

o occ

ur)

Patie

nts f

or w

hom

the v

alue o

f the

OAS

ISite

m M

0420

Freq

uenc

y of P

ain at

the s

tart

of or

resu

mpt

ion

of ca

re is

>0

(i.e.,

it is

poss

ible

for i

mpr

ovem

ent t

o occ

ur)

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

ad

miss

ion

to an

inpa

tient

facil

ity or

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

ad

miss

ion

to an

inpa

tient

facil

ity or

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

ad

miss

ion

to an

inpa

tient

facil

ity or

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

5A

lthou

gh th

is m

easu

re is

ris

k ad

just

ed b

y C

MS

for

its H

ome

Hea

lth C

ompa

rew

eb s

ite, t

he m

easu

re is

not

ris

k ad

just

ed fo

r O

BQI r

epor

ts. T

he N

QF-

endo

rsed

ver

sion

is r

isk

adju

sted

.

A-4

Appe

ndix

A –

Spe

cific

atio

ns o

f the

Nat

iona

l Vol

unta

ry C

onse

nsus

Sta

ndar

ds fo

r Hom

e He

alth

Car

e (c

ontin

ued)

Fram

ewor

k Ca

tego

ryM

easu

reSo

urce

of M

easu

reNu

mer

ator

Deno

min

ator

Exclu

sions

Phys

iolo

gic

cont

inue

d6.

Impr

ovem

ent

in st

atus

of

surg

ical

wou

nds

7.Im

prov

emen

tin

dys

pnea

1

OASI

S/OB

QI2,

3,4

OASI

S/OB

QI2,

3,4

Patie

nts f

or w

hom

:■

the v

alue o

f OAS

IS it

emM

0488

Stat

us of

Mos

tPr

oblem

atic

(Obs

erva

ble)

Surg

ical W

ound

(a sc

alera

ngin

g fro

m 1

to 3

) at

disc

harg

e fro

m h

ome h

ealth

care

is lo

wer n

umer

ically

(indi

catin

g m

ore h

ealin

g)th

an th

e valu

e of t

he sa

me

item

at th

e sta

rt of

orre

sum

ptio

n of

care

OR

■th

e valu

e of O

ASIS

item

M04

82 Su

rgica

l Wou

nd or

M04

40 Sk

in Le

sion

or O

pen

Wou

nd (0

-1 in

dica

tors)

atdi

scha

rge f

rom

hom

e hea

lthca

re is

0,a

nd th

e valu

e of

M04

82 Su

rgica

l Wou

nd at

the s

tart

of or

resu

mpt

ion

of ca

re is

1

Patie

nts f

or w

hom

the v

alue

of O

ASIS

item

M04

90 Sh

ort o

fBr

eath

(a sc

ale ra

ngin

g fro

m

0 to

4) a

t disc

harg

e fro

m

hom

e hea

lth ca

re is

lowe

rnu

mer

ically

(ind

icatin

g les

sim

pairm

ent)

than

the v

alue

of th

e sam

e ite

m at

the s

tart

of or

resu

mpt

ion

of ca

re

Patie

nts f

or w

hom

:■

the v

alue o

f the

OAS

IS it

em M

0482

Surg

ical W

ound

at th

e sta

rt of

orre

sum

ptio

n of

care

is >

0 (i.

e.,it

is po

ssib

le fo

r im

prov

emen

t to o

ccur

) AND

■th

e valu

e of O

ASIS

item

M04

88 St

atus

ofM

ost P

robl

emat

ic (O

bser

vabl

e) Su

rgica

lW

ound

is n

ot eq

ual t

o “NA

- No

Obse

rvab

le Su

rgica

l Wou

nd”

Patie

nts f

or w

hom

the v

alue o

f the

OAS

ISite

m M

0490

Shor

t of B

reat

h at

the s

tart

of or

resu

mpt

ion

of ca

re is

>0

(i.e.,

it is

poss

ible

for i

mpr

ovem

ent t

o occ

ur)

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

ad

miss

ion

to an

inpa

tient

facil

ity or

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

ad

miss

ion

to an

inpa

tient

facil

ity or

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

A-5

Appe

ndix

A –

Spe

cific

atio

ns o

f the

Nat

iona

l Vol

unta

ry C

onse

nsus

Sta

ndar

ds fo

r Hom

e He

alth

Car

e (c

ontin

ued)

Fram

ewor

k Ca

tego

ryM

easu

reSo

urce

of M

easu

reNu

mer

ator

Deno

min

ator

Exclu

sions

Phys

iolo

gic

cont

inue

d8.

Impr

ovem

ent

in u

rinar

yin

cont

inen

ce1

9.In

creas

e in

num

ber o

fpr

essu

re u

lcers

OASI

S/OB

QI2,

3,4

OASI

S/OB

QM2,

3,4

Patie

nts f

or w

hom

:■

the v

alue o

f OAS

IS it

emM

0520

Urin

ary I

ncon

tinen

ceor

Urin

ary C

athe

ter P

rese

nce

at d

ischa

rge f

rom

hom

ehe

alth

care

indi

cate

s no

inco

ntin

ence

whe

n in

cont

i-ne

nce w

as in

dica

ted

at st

art

or re

sum

ptio

n of

care

OR

■th

e valu

e of O

ASIS

item

M05

20 U

rinar

y Inc

ontin

ence

or U

rinar

y Cat

hete

r Pre

senc

eat

disc

harg

e ind

icate

s no

cath

eter

whe

n ca

thet

er w

asin

dica

ted

as p

rese

nt at

star

tor

resu

mpt

ion

of ca

re O

R■

the v

alue o

f OAS

IS it

emM

0530

Urin

ary I

ncon

tinen

ce(a

scale

of 0

to 2

) at

disc

harg

e fro

m h

ome h

ealth

care

is lo

wer n

umer

ically

(indi

catin

g les

s fre

quen

tin

cont

inen

ce) t

han

the v

alue

of th

e sam

e ite

m at

the s

tart

of or

resu

mpt

ion

of ca

rew

hen

urin

ary i

ncon

tinen

ceoc

curs

Patie

nts f

or w

hom

on O

ASIS

item

M04

50 th

ere a

re m

ore

pres

sure

ulce

rs (a

ll sta

ges 1

-4)

at th

e end

of ca

re th

an th

ere

were

at th

e beg

inni

ng ti

me

poin

t (su

mm

ed ac

ross

all 4

stage

s at e

ach

time p

oint

)

Patie

nts f

or w

hom

the v

alue o

f the

OAS

ISite

ms M

0520

Urin

ary I

ncon

tinen

ce or

Urin

ary C

athe

ter P

rese

nce o

r M05

30Ur

inar

y Inc

ontin

ence

at st

art o

r res

umpt

ion

of ca

re is

>0

(i.e.,

it is

poss

ible

for

impr

ovem

ent t

o occ

ur)

Patie

nts f

or w

hom

on O

ASIS

item

M04

50 it

is po

ssib

le to

hav

e mor

e pre

ssur

e ulce

rs at

the e

nd ti

me p

oint

than

at th

e beg

inni

ngtim

e poi

nt (

If th

ere i

s no w

ound

or

pres

sure

ulce

r at o

ne or

bot

h tim

e poi

nts,

then

a co

unt o

f 0 is

assig

ned

for t

he ti

me

poin

t in

ques

tion)

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

ad

miss

ion

to an

inpa

tient

facil

ity or

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

■Nu

mbe

r of p

ress

ure u

lcers

is 16

at th

e beg

inni

ngtim

e poi

nt■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

ad

miss

ion

to an

inpa

tient

facil

ity or

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

A-6

Appe

ndix

A –

Spe

cific

atio

ns o

f the

Nat

iona

l Vol

unta

ry C

onse

nsus

Sta

ndar

ds fo

r Hom

e He

alth

Car

e (c

ontin

ued)

Fram

ewor

k Ca

tego

ryM

easu

reSo

urce

of M

easu

reNu

mer

ator

Deno

min

ator

Exclu

sions

Safe

ty

Utili

zatio

n

10.E

mer

gent

care

for w

ound

infe

ctio

ns,

dete

riora

ting

woun

d sta

tus

11.E

mer

gent

care

for i

mpr

oper

med

icatio

nad

min

istra

tion,

med

icatio

nsid

e effe

cts

12.E

mer

gent

ca

re fo

r hyp

o/hy

perg

lycem

ia

13.A

cute

care

ho

spita

lizat

ion1

14.D

ischa

rge t

oco

mm

unity

1

OASI

S/OB

QM2,

3,4

OASI

S/OB

QM2,

3,4

OASI

S/OB

QM2,

3,4

OASI

S/OB

QI2,

3,4

OASI

S/OB

QI2,

3,4

Patie

nts f

or w

hom

this

even

tha

ppen

s (em

erge

nt ca

re

reas

on is

wou

nd in

fect

ion

orde

terio

ratin

g w

ound

stat

us) o

ntra

nsfe

r to i

npat

ient f

acilit

y or

disc

harg

e fro

m ag

ency

Patie

nts f

or w

hom

this

even

tha

ppen

s (em

erge

nt ca

re

reas

on is

impr

oper

med

icatio

nad

min

istra

tion

or m

edica

tion

side e

ffect

s) on

tran

sfer t

oin

patie

nt fa

cility

or d

ischa

rge

from

agen

cy

Patie

nts f

or w

hom

this

even

tha

ppen

s (em

erge

nt ca

re re

ason

is hy

po/h

yper

glyc

emia)

ontra

nsfe

r to i

npat

ient f

acilit

y or

disc

harg

e fro

m ag

ency

Patie

nts f

or w

hom

the r

espo

nse

on O

ASIS

item

M08

55 In

patie

ntFa

cility

Adm

issio

n is

1-Ho

spita

l

Patie

nts f

or w

hom

the v

alue o

fM

0100

Rea

son

for A

sses

smen

tfo

r the

episo

de of

care

end

poin

t ass

essm

ent i

s equ

al to

9-

Disc

harg

e fro

m A

genc

y,an

d th

e res

pons

e to M

0870

Disc

harg

e Disp

ositi

on is

1-

Patie

nt re

main

ed in

the

com

mun

ity

All e

mer

gent

care

reas

ons (

exce

pt“u

nkno

wn”

on M

0840

) and

pat

ients

for

who

m n

o em

erge

nt u

tiliza

tion

occu

rred

All e

mer

gent

care

reas

ons (

exce

pt“u

nkno

wn”

on M

0840

) and

pat

ients

for

who

m n

o em

erge

nt u

tiliza

tion

occu

rred

All e

mer

gent

care

reas

ons (

exce

pt

unkn

own

on M

0840

) and

pat

ients

for

who

m n

o em

erge

nt u

tiliza

tion

occu

rred

All p

atien

ts

All p

atien

ts

■Ep

isode

s of h

ome c

are e

ndin

g w

ith d

eath

■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

■Ep

isode

s of h

ome c

are e

ndin

g w

ith d

eath

■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

■Ep

isode

s of h

ome c

are e

ndin

g w

ith d

eath

■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

■Re

spon

se to

M08

70 D

ischa

rge D

ispos

ition

is“u

nkno

wn”

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

A-7

Appe

ndix

A –

Spe

cific

atio

ns o

f the

Nat

iona

l Vol

unta

ry C

onse

nsus

Sta

ndar

ds fo

r Hom

e He

alth

Car

e (c

ontin

ued)

Fram

ewor

k Ca

tego

ryM

easu

reSo

urce

of M

easu

reNu

mer

ator

Deno

min

ator

Exclu

sions

Utili

zatio

nco

ntin

ued

15.E

mer

gent

care

1OA

SIS/

OBQI

2,3,

4Pa

tient

s for

who

m th

e res

pons

eon

OAS

IS it

em M

0830

Emer

gent

Care

is 1

-Hos

pita

l em

erge

ncy

room

,2-D

octo

r’s of

fice

emer

genc

y visi

t/hou

se ca

ll,or

3-O

utpa

tient

dep

artm

ent/

clini

c em

erge

ncy

All p

atien

ts■

Valu

e of t

he O

ASIS

item

M08

30 Em

erge

nt Ca

re

at d

ischa

rge o

r tra

nsfe

r is “

unkn

own”

■No

n-re

spon

sive a

t sta

rt or

resu

mpt

ion

of ca

re■

Episo

des o

f hom

e hea

lth ca

re en

ding

with

dea

th■

Mat

erni

ty p

atien

ts■

<18

year

s of a

ge

A-8 NATIONAL QUALITY FORUM

Table 1 – Outcome Measure Transformation Documentation*

MEASURE TRANSFORMATION DOCUMENTATION

Improvement in ambulation/locomotion

Improvement in bathing

IF M0700_CUR_AMBULATION NOT = 00, 01, 02, 03, 04, 05 OR M0700_CUR_AMBULATION[2] NOT = 00, 01, 02, 03, 04, 05

THEN IMP_AMBULATION = MISSING ‘[SHOULD NEVER OCCUR]

ELSE IF (M0700_CUR_AMBULATION = 01 AND M0700_CUR_AMBULATION[2] = 00) OR (M0700_CUR_AMBULATION = 02 AND M0700_CUR_AMBULATION[2] = 00, 01) OR (M0700_CUR_AMBULATION = 03 AND M0700_CUR_AMBULATION[2] = 00, 01, 02) OR (M0700_CUR_AMBULATION = 04 AND M0700_CUR_AMBULATION[2] = 00, 01, 02, 03) OR (M0700_CUR_AMBULATION = 05 AND M0700_CUR_AMBULATION[2] = 00, 01, 02, 03, 04)

THEN IMP_AMBULATION = 1

ELSE IF (M0700_CUR_AMBULATION = 01 AND M0700_CUR_AMBULATION[2] = 01, 02, 03, 04, 05) OR(M0700_CUR_AMBULATION = 02 AND M0700_CUR_AMBULATION[2] = 02, 03, 04, 05) OR (M0700_CUR_AMBULATION = 03 AND M0700_CUR_AMBULATION[2] = 03, 04, 05) OR (M0700_CUR_AMBULATION = 04 AND M0700_CUR_AMBULATION[2] = 04, 05) OR (M0700_CUR_AMBULATION = 05 AND M0700_CUR_AMBULATION[2] = 05)

THEN IMP_AMBULATION = 0 ELSE IF M0700_CUR_AMBULATION = 00

THEN IMP_AMBULATION = MISSING

IF M0670_CUR_BATHING NOT = 00, 01, 02, 03, 04, 05 OR M0670_CUR_BATHING[2] NOT = 00, 01, 02, 03, 04, 05

THEN IMP_BATHING = MISSING STAB_BATHING = MISSING ‘[SHOULD NEVER OCCUR]

ELSE IF (M0670_CUR_BATHING = 01 AND M0670_CUR_BATHING[2] = 00) OR (M0670_CUR_BATHING = 02 AND M0670_CUR_BATHING[2] = 00, 01) OR (M0670_CUR_BATHING = 03 AND M0670_CUR_BATHING[2] = 00, 01, 02) OR (M0670_CUR_BATHING = 04 AND M0670_CUR_BATHING[2] = 00, 01, 02, 03) OR (M0670_CUR_BATHING = 05 AND M0670_CUR_BATHING[2] = 00, 01, 02, 03, 04)

THEN IMP_BATHING = 1

ELSE IF (M0670_CUR_BATHING = 01 AND M0670_CUR_BATHING[2] = 01, 02, 03, 04, 05) OR (M0670_CUR_BATHING = 02 AND M0670_CUR_BATHING[2] = 02, 03, 04, 05) OR (M0670_CUR_BATHING = 03 AND M0670_CUR_BATHING[2] = 03, 04, 05) OR (M0670_CUR_BATHING = 04 AND M0670_CUR_BATHING[2] = 04, 05) OR (M0670_CUR_BATHING = 05 AND M0670_CUR_BATHING[2] = 05)

THEN IMP_BATHING = 0

ELSE IF M0670_CUR_BATHING = 00

THEN IMP_BATHING = MISSING

* Transformation documentation is the formula or logical expression indicating how the measure is calculated from specificOASIS data fields.

NATIONAL VOLUNTARY CONSENSUS STANDARDS FOR HOME HEALTH CARE: A CONSENSUS REPORT A-9

Table 1 – Outcome Measure Transformation Documentation* (continued)


Improvement in transferring

Improvement in management of oral medications

Improvement in pain interfering with activity

IF M0690_CUR_TRANSFERRING NOT = 00, 01, 02, 03, 04, 05 OR M0690_CUR_TRANSFERRING[2] NOT = 00, 01, 02, 03, 04, 05

THEN IMP_TRANSFERRING = MISSING STAB_TRANSFERRING = MISSING ‘[SHOULD NEVER OCCUR]

ELSE IF (M0690_CUR_TRANSFERRING = 01 AND M0690_CUR_TRANSFERRING[2] = 00) OR (M0690_CUR_TRANSFERRING = 02 AND M0690_CUR_TRANSFERRING[2] = 00, 01) OR (M0690_CUR_TRANSFERRING = 03 AND M0690_CUR_TRANSFERRING[2] = 00, 01, 02) OR(M0690_CUR_TRANSFERRING = 04 AND M0690_CUR_TRANSFERRING[2] = 00,01,02,03) OR(M0690_CUR_TRANSFERRING = 05 AND M0690_CUR_TRANSFERRING[2] = 00,01,02,03,04)

THEN IMP_TRANSFERRING = 1

ELSE IF (M0690_CUR_TRANSFERRING = 01 AND M0690_CUR_TRANSFERRING[2] = 01, 02, 03, 04, 05) OR(M0690_CUR_TRANSFERRING = 02 AND M0690_CUR_TRANSFERRING[2] = 02,03,04,05) OR(M0690_CUR_TRANSFERRING = 03 AND M0690_CUR_TRANSFERRING[2] = 03, 04, 05) OR(M0690_CUR_TRANSFERRING = 04 AND M0690_CUR_TRANSFERRING[2] = 04, 05) OR (M0690_CUR_TRANSFERRING = 05 AND M0690_CUR_TRANSFERRING[2] = 05)

THEN IMP_TRANSFERRING = 0

ELSE IF M0690_CUR_TRANSFERRING = 00

THEN IMP_TRANSFERRING = MISSING

IF M0780_CUR_ORAL_MEDS NOT = 00, 01, 02, NA OR M0780_CUR_ORAL_MEDS[2] NOT = 00, 01, 02, NA

THEN IMP_ORALMEDS = MISSING STAB_ORALMEDS = MISSING ‘[SHOULD NEVER OCCUR]

ELSE IF (M0780_CUR_ORAL_MEDS = 01 AND M0780_CUR_ORAL_MEDS[2] = 00) OR (M0780_CUR_ORAL_MEDS = 02 AND M0780_CUR_ORAL_MEDS[2] = 00, 01)

THEN IMP_ORALMEDS = 1

ELSE IF (M0780_CUR_ORAL_MEDS = 01 AND M0780_CUR_ORAL_MEDS[2] = 01, 02) OR (M0780_CUR_ORAL_MEDS = 02 AND M0780_CUR_ORAL_MEDS[2] = 02)

THEN IMP_ORALMEDS = 0

ELSE IF M0780_CUR_ORAL_MEDS = 00, NA OR M0780_CUR_ORAL_MEDS[2] = NA

THEN IMP_ORALMEDS = MISSING

IF M0420_FREQ_PAIN NOT = 00, 01, 02, 03 OR M0420_FREQ_PAIN[2] NOT = 00, 01, 02, 03

THEN IMP_PAIN = MISSING ‘[SHOULD NEVER OCCUR]

ELSE IF (M0420_FREQ_PAIN = 01 AND M0420_FREQ_PAIN[2] = 00) OR (M0420_FREQ_PAIN = 02 AND M0420_FREQ_PAIN[2] = 00, 01) OR (M0420_FREQ_PAIN = 03 AND M0420_FREQ_PAIN[2] = 00, 01, 02)

THEN IMP_PAIN = 1

ELSE IF (M0420_FREQ_PAIN = 01 AND M0420_FREQ_PAIN[2] = 01, 02, 03) OR (M0420_FREQ_PAIN = 02 AND M0420_FREQ_PAIN[2] = 02, 03) OR (M0420_FREQ_PAIN = 03 AND M0420_FREQ_PAIN[2] = 03)

THEN IMP_PAIN = 0 ELSE IF M0420_FREQ_PAIN = 00

THEN IMP_PAIN = MISSING





Improvement instatus of surgicalwounds

Improvement in dyspnea

IF M0440_LESION_WND = 0 OR M0482_SURG_WOUND = 0

THEN STAT_INT1 = 00

ELSE IF M0482_SURG_WOUND = 1

THEN STAT_INT1 = M0488_STAT_PRB_SURGWND

IF M0440_LESION_WND[2] = 0 OR M0482_SURG_WOUND[2] = 0

THEN STAT_INT2 = 00

ELSE IF M0482_SURG_WOUND[2] = 1

THEN STAT_INT2 = M0488_STAT_PRB_SURGWND[2]

IF ((M0440_LESION_OPEN_WND = 1 OR M0482_SURG_WOUND = 1) AND STAT_INT1 NOT = 00, 01, 02, 03, NA) OR((M0440_LESION_OPEN_WND[2] = 1 ORM0482_SURG_WOUND[2] = 1) AND STAT_INT2 NOT = 00, 01, 02, 03, NA)

THEN IMP_STATUSWOUNDS = MISSING ‘[SHOULD NEVER OCCUR]

ELSE IF (STAT_INT1 = 01 AND STAT_INT2 = 00) OR (STAT_INT1 = 02 AND STAT_INT2 = 00, 01) OR (STAT_INT1 = 03 AND STAT_INT2 = 00, 01, 02)

THEN IMP_STATUSWOUNDS = 1

ELSE IF (STAT_INT1 = 01 AND STAT_INT2 = 01, 02, 03) OR (STAT_INT1 = 02 AND STAT_INT2 = 02, 03) OR(STAT_INT1 = 03 AND STAT_INT2 = 03)

THEN IMP_STATUSWOUNDS = 0

ELSE IF (STAT_INT1 = 00, NA) OR (STAT_INT2 = NA)

THEN IMP_STATUSWOUNDS = MISSING

IF M0490_WHEN_DYSPNEIC NOT = 00, 01, 02, 03, 04 OR M0490_WHEN_DYSPNEIC[2] NOT = 00, 01, 02, 03, 04

THEN IMP_DYSPNEA = MISSING ‘[SHOULD NEVER OCCUR]

ELSE IF (M0490_WHEN_DYSPNEIC = 01 AND M0490_WHEN_DYSPNEIC[2] = 00) OR (M0490_WHEN_DYSPNEIC = 02 AND M0490_WHEN_DYSPNEIC[2] = 00, 01) OR (M0490_WHEN_DYSPNEIC = 03 AND M0490_WHEN_DYSPNEIC[2] = 00, 01, 02) OR (M0490_WHEN_DYSPNEIC = 04 AND M0490_WHEN_DYSPNEIC[2] = 00, 01, 02, 03)

THEN IMP_DYSPNEA = 1

ELSE IF (M0490_WHEN_DYSPNEIC = 01 AND M0490_WHEN_DYSPNEIC[2] = 01, 02, 03, 04) OR(M0490_WHEN_DYSPNEIC = 02 AND M0490_WHEN_DYSPNEIC[2] = 02, 03, 04) OR (M0490_WHEN_DYSPNEIC = 03 AND M0490_WHEN_DYSPNEIC[2] = 03, 04) OR (M0490_WHEN_DYSPNEIC = 04 AND M0490_WHEN_DYSPNEIC[2] = 04)

THEN IMP_DYSPNEA = 0

ELSE IF M0490_WHEN_DYSPNEIC = 00

THEN IMP_DYSPNEA = MISSING





Improvement in urinary incontinence

IF M0520_UR_INCONT NOT = 00, 01, 02 OR (M0520_UR_INCONT = 01 AND MO530_UR_INCONT_OCCURS NOT = 00, 01, 02) OR (M0520_UR_INCONT = 00, 02 ANDM0530_UR_INCONT_OCCURS = 00, 01, 02) OR M0520_UR_INCONT[2] NOT = 00, 01, 02 OR(M0520_UR_INCONT[2] = 01 AND MO530_UR_INCONT_OCCURS[2] NOT = 00, 01, 02) ORM0520_UR_INCONT[2] = 00, 02 AND M0530_UR_INCONT_OCCURS[2] = 00, 01, 02)

THEN OUT_INTERIM1 = MISSINGOUT_INTERIM2 = MISSING ‘[SHOULD NEVER OCCUR]

ELSE IF M0520_UR_INCONT = 00

THEN OUT_INTERIM1 = 0

ELSE IF M0530_UR_INCONT_OCCURS = 00








IF M0520_UR_INCONT[2] = 00


ELSE IF M0530_UR_INCONT_OCCURS[2] = 00






ELSE IF M0520_UR_INCONT[2] = 02


IF OUT_INTERIM1 = NOT = 0, 1, 2, 3, 4, OR OUT_INTERIM2 NOT = 0, 1, 2, 3, 4

THEN IMP_INCONT = MISSING ‘[SHOULD NEVER OCCUR]

ELSE IF (OUT_INTERIM1 = 1 AND OUT_INTERIM2 = 0) OR (OUT_INTERIM1 = 2 AND OUT_INTERIM2 = 0, 1) OR (OUT_INTERIM1 = 3 AND OUT_INTERIM2 = 0, 1, 2) OR (OUT_INTERIM1 = 4 AND OUT_INTERIM2 = 0, 1, 2, 3)

THEN IMP_INCONT = 1

ELSE IF (OUT_INTERIM1 = 1 AND OUT_INTERIM2 = 1, 2, 3, 4) OR (OUT_INTERIM1 = 2 AND OUT_INTERIM2 = 2, 3, 4) OR (OUT_INTERIM1 = 3 AND OUT_INTERIM2 = 3, 4) OR (OUT_INTERIM1 = 4 AND OUT_INTERIM2 = 4)

THEN IMP_INCONT = 0

ELSE IF OUT_INTERIM1 = 0

THEN IMP_INCONT = MISSING





Increase in number of pressure ulcers

Emergent care forwound infections,deteriorating woundstatus

Emergent care forimproper medicationadministration,medication side effects

Emergent care forhypo/hyperglycemia

Acute care hospitalization

1 if PRESSURE1 < 16 and PRESSURE2 > PRESSURE1;

0 if M0100_ASSMT_REASON[2] = 09 and PRESSURE1 < 16, and PRESSURE2 <= PRESSURE1; MISSING Otherwise.

This measure requires the computation of two interim measures. PRESSURE1 represents the number of stageablepressure ulcers at SOC/ROC while PRESSURE2 represents the number of stageable pressure ulcers at DC.

PRESSURE1

M0450_NBR_PRSULC_STG1 + M0450_NBR_PRSULC_STG2 + M0450_NBR_PRSULC_STG3 +M0450_NBR_PRSULC_STG4

if M0100_ASSMT_REASON[2] = 09 and M0440_LESION_OPEN_WND = 1 and M0445_PRESS_ULCER = 1;

0 if M0100_ASSMT_REASON[2] = 09 and (M0440_LESION_OPEN_WND = 0 or M0445_PRESS_ULCER = 0);MISSING otherwise.

PRESSURE2M0450_NBR_PRSULC_STG1[2] + M0450_NBR_PRSULC_STG2[2] + M0450_NBR_PRSULC_STG3[2] +M0450_NBR_PRSULC_STG4[2]

if M0100_ASSMT_REASON[2] = 09 and M0440_LESION_OPEN_WND[2] = 1 and M0445_PRESS_ULCER[2] = 1;

0 if M0100_ASSMT_REASON[2] = 09 and (M0440_LESION_OPEN_WND[2] = 0 or M0445_PRESS_ULCER[2] = 0);MISSING otherwise.

1 if M0100_ASSMT_REASON[2] = 06,07,09 and M0840_ECR_WOUND[2] = 1;

0 if M0100_ASSMT_REASON[2] = 06,07,09 and M0830_EC_UNKNOWN[2] = 0 and (M0830_EC_NONE[2] = 1 or M0840_ECR_UNKNOWN[2] = 0); MISSING Otherwise.

1 if M0100_ASSMT_REASON[2] = 06,07,09 and M0840_ECR_MEDICATION[2] = 1;


1 if M0100_ASSMT_REASON[2] = 06,07,09 and M0840_ECR_HYPOGLYC[2] = 1;


IF (M0100_ASSMT_REASON[2] = 06, 07 AND M0855_INPAT_FACILITY[2] NOT = 01, 02, 03, 04) OR(M0100_ASSMT_REASON[2] = 09 AND M0855_INPAT_FACILITY[2] NOT = NA) OR (M0855_INPAT_FACILITY[2] = 01 AND M0890_HOSP_RSN[2] NOT = 01, 02, 03, UK)

THEN UTIL_HOSPDC = MISSING '[SHOULD NEVER OCCUR]

ELSE IF (M0100_ASSMT_REASON[2] = 06, 07 AND M0855_INPAT_FACILITY [2]= 01)

THEN UTIL_HOSPDC = 1 ELSE UTIL_HOSPDC = 0





Discharge to community

Emergent care

IF M0100_ASSMT_REASON[2] = 09 AND M0870_DSCHG_DISP[2] NOT = 01, 02, 03, UK

THEN UTIL_DCCOMM = MISSING '[SHOULD NEVER OCCUR]

ELSE IF M0100_ASSMT_REASON[2] = 09 AND M0870_DSCHG_DISP[2] = 01

THEN UTIL_DCCOMM = 1

ELSE IF (M0100_ASSMT_REASON[2] = 09 AND M0870_DSCHG_DISP[2] = 02, 03) OR M0100_ASSMT_REASON[2] = 06, 07

THEN UTIL_DCCOMM = 0

ELSE IF M0870_DSCHG_DISP[2] = UK

THEN UTIL_DCCOMM = MISSING

IF M0830_EC_NONE[2] NOT = 0, 1 OR M0830_EC_EMER_ROOM[2] NOT = 0, 1 OR M0830_EC_MD_OFF[2] NOT = 0, 1 OR M0830_EC_OUTPAT[2] NOT = 0, 1 OR M0830_EC_UNKNOWN[2] NOT = 0, 1 OR ((M0830_EC_UNKNOWN[2] = 1 OR M0830_EC_NONE[2] = 1) AND(M0830_EC_EMER_ROOM[2] = 1 OR M0830_EC_MD_OFF[2] = 1 OR M0830_EC_OUTPAT[2] = 1)) OR(M0830_EC_NONE[2] = 0 AND M0830_EC_EMER_ROOM[2] = 0 AND M0830_EC_MD_OFF[2] = 0 ANDM0830_EC_OUTPAT[2] = 0 AND M0830_EC_UNKNOWN[2] = 0) OR (M0830_EC_UNKNOWN[2] = 1 ANDM0830_EC_NONE[2] = 1)

THEN UTIL_EMERGENT = MISSING ‘[SHOULD NEVER OCCUR]

ELSE IF M0830_UNKNOWN[2] = 1

THEN UTIL_EMERGENT = MISSING

ELSE IF M0830_EC_NONE[2] = 0

THEN UTIL_EMERGENT = 1

ELSE IF M0830_EC_NONE[2] = 1

THEN UTIL_EMERGENT = 0


Sources:

U.S. Department of Health and Human Services (DHHS). Outcome-Based Quality Improvement Reports: Technical Documentation ofMeasures. Baltimore, MD: Centers for Medicare and Medicaid Services (CMS); September 2003. Available at www.cms.hhs.gov/oasis/riskadjappb.pdf. Last accessed August 17, 2004.U.S. DHHS. Outcome-Based Quality Monitoring Reports: Technical Documentation of Measures. Baltimore, MD: CMS. March 2002;Revised (Corrections Made) October 2003.


Members*

CONSUMER COUNCILAARPAFL-CIOAFT HealthcareAmerican Hospice FoundationConsumers Advancing Patient SafetyConsumers’ CheckbookConsumer Coalition for Quality

Health CareMarch of DimesNational Citizens’ Coalition for

Nursing Home ReformNational Coalition for Cancer

SurvivorshipNational Family Caregivers

AssociationNational Partnership for Women and

FamiliesService Employees International Union

HEALTH PROFESSIONAL, PROVIDER,AND HEALTH PLAN COUNCILAdministrators for the ProfessionsAdventist HealthCareAetnaAlexian Brothers Medical CenterAlliance for Quality Nursing Home

CareAmerican Academy of Family

PhysiciansAmerican Academy of Orthopaedic

SurgeonsAmerican Association of Homes and

Services for the Aging

American Association of NurseAnesthetists

American Association of NurseAssessment Coordinators

American College of CardiologyAmerican College of Gastroenterology American College of Obstetricians and

GynecologistsAmerican College of PhysiciansAmerican College of RadiologyAmerican College of SurgeonsAmerican Health Care AssociationAmerican Heart AssociationAmerican Hospital AssociationAmerican Managed Behavioral

Healthcare AssociationAmerican Medical AssociationAmerican Medical Group AssociationAmerican Nurses AssociationAmerican Optometric AssociationAmerican Osteopathic AssociationAmerican Psychiatric Institute for

Research and EducationAmerican Society for Therapeutic

Radiology and OncologyAmerican Society of Clinical OncologyAmerican Society of Health-System

PharmacistsAmerica’s Health Insurance PlansAscension HealthAssociation for Professionals in

Infection Control and EpidemiologyAssociation of Professors of MedicineAurora Health Care

B-1

*When voting under the NQF Consensus Development Process occurred for this report.

Appendix B

Members and Board of Directors

Bayhealth Medical CenterBaylor Health Care SystemBeacon Health StrategiesBeverly EnterprisesBJC HealthCareBlue Cross and Blue Shield AssociationBlue Cross Blue Shield of MichiganBon Secours Health SystemBronson Healthcare GroupCalgary Health RegionCatholic Health Association of the United StatesCatholic Healthcare PartnersCatholic Health InitiativesCentura HealthChild Health Corporation of AmericaCHRISTUS HealthCIGNA HealthcareCollege of American PathologistsConnecticut Hospital AssociationCouncil of Medical Specialty SocietiesDetroit Medical CenterEmpire BlueCross/BlueShieldExempla HealthcareFederation of American HospitalsFirst HealthFlorida Hospital Medical CenterGentiva Health ServicesGood Samaritan HospitalGreater New York Hospital AssociationHackensack University Medical CenterHCAHealthcare Leadership CouncilHealthHelpHealthPartnersHealth PlusHenry Ford Health SystemHoag HospitalHorizon Blue Cross and Blue Shield of New JerseyHudson Health PlanIllinois Hospital AssociationINTEGRIS HealthJohn Muir/Mount Diablo Health SystemKaiser PermanenteKU Med at the University of Kansas Medical CenterLos Angeles County-Department of Health ServicesLutheran Medical CenterMayo FoundationMedQuest AssociatesMemorial Health University Medical CenterMemorial Sloan-Kettering Cancer CenterThe Methodist HospitalMilliman Care GuidelinesNational Association for Homecare and HospiceNational Association Medical Staff Services

National Association of Chain Drug StoresNational Association of Children’s Hospitals and

Related InstitutionsNational Association of Public Hospitals and

Health SystemsNational Consortium of Breast CentersNational Hospice and Palliative Care OrganizationNational Rural Health AssociationNebraska Heart HospitalsNemours FoundationNew York Presbyterian Hospital and Health SystemNorth Carolina Baptist HospitalNorth Shore-Long Island Jewish Health SystemNorth Texas Specialty PhysiciansNorton HealthcareOakwood Healthcare SystemPacifiCarePacifiCare Behavioral HealthParkview Community Hospital and Medical CenterPartners HealthCarePremierRobert Wood Johnson University Hospital-HamiltonRobert Wood Johnson University Hospital–

New BrunswickSentara Norfolk General HospitalSisters of Charity of Leavenworth Health SystemSisters of Mercy Health SystemSociety of Thoracic SurgeonsSpectrum HealthState Associations of Addiction ServicesState University of New York-College of OptometrySt. Mary’s Hospital Medical CenterSt. Vincent Regional Medical CenterSutter HealthTampa General HospitalTenet HealthcareTriad HospitalsTrinity HealthUnitedHealth GroupUniversity Health System ConsortiumUniversity Health Systems of Eastern CarolinaUniversity Hospitals of ClevelandUniversity of California-Davis Medical GroupUniversity of Michigan Hospitals and Health CentersUniversity of Pennsylvania Health SystemUniversity of Texas-MD Anderson Cancer CenterUS Department of Defense-Health AffairsVail Valley Medical CenterVanguard Health ManagementVeterans Health AdministrationVHA, Inc.WellPointYale-New Haven Health System

B-2 NATIONAL QUALITY FORUM

NATIONAL VOLUNTARY CONSENSUS STANDARDS FOR HOME HEALTH CARE: A CONSENSUS REPORT B-3

PURCHASER COUNCILBoozAllenHamiltonBuyers Health Care Action GroupCenters for Medicare and Medicaid ServicesCentral Florida Health Care CoalitionDistrict of Columbia Department of HealthEmployer Health Care Alliance Cooperative

(The Alliance)Employers’ Coalition on HealthFord Motor CompanyGeneral MotorsGreater Detroit Area Health CouncilHealthCare 21The Leapfrog GroupLehigh Valley Business Conference on HealthMaine Health Management CoalitionMidwest Business Group on HealthNational Association of State Medicaid DirectorsNational Business Coalition on HealthNational Business Group on HealthNew Jersey Health Care Quality InstitutePacific Business Group on HealthSchaller AndersonSouth Central Michigan Health AllianceUS Office of Personnel ManagementWashington State Health Care Authority

RESEARCH AND QUALITY IMPROVEMENT COUNCILAAAHC-Institute for Quality ImprovementAbbott LaboratoriesACC/AHA Task Force on Performance MeasuresACS/MIDAS+Agency for Healthcare Research and QualityAI InsightAmerican Academy of NursingAmerican Association of Colleges of NursingAmerican Board for Certification in Orthotics

and ProstheticsAmerican Board of Internal Medicine FoundationAmerican Board of Medical SpecialtiesAmerican College of Medical QualityAmerican Health Quality AssociationAmerican Pharmacists Association FoundationAmerican Psychiatric Institute for Research and

EducationAmerican Society for Quality-Health Care DivisionAnesthesia Patient Safety FoundationAspect Medical SystemsAssociation for Professionals in Infection Control

and EpidemiologyAssociation of American Medical CollegesAventis PharmaceuticalsCalifornia HealthCare Foundation

Cancer Quality Council of OntarioCardinal HealthCareScienceCenter to Advance Palliative CareCenters for Disease Control and PreventionCity of New York Department of Health and HygieneCleveland Clinic FoundationCoral InitiativeCouncil for Affordable Quality HealthcareCRG MedicalDelmarva FoundationDialog MedicaleHealth InitiativeEli Lilly and CompanyFirst Consulting GroupFlorida Initiative for Children’s Healthcare QualityForum of End Stage Renal Disease NetworksHealth Care ExcelHealth GradesHealth Resources and Services AdministrationIllinois Department of Public HealthInstitute for Clinical Systems ImprovementInstitute for Safe Medication PracticesIntegrated Healthcare AssociationIntegrated Resources for the Middlesex AreaIowa Foundation for Medical CareIPROJefferson Health System Office of Health Policy

and Clinical OutcomesJoint Commission on Accreditation of Healthcare

OrganizationsLong Term Care InstituteLoyola University Health System-Center for

Clinical EffectivenessLumetraMaine Quality ForumMedical Review of North CarolinaMedstatNational Academy of State Health PolicyNational Association for Healthcare QualityNational Committee for Quality AssuranceNational Committee for Quality Health CareNational Institutes of HealthNational Patient Safety FoundationNational Research CorporationNew England Healthcare AssemblyNiagara Health Quality CoalitionNortheast Health Care Quality FoundationOhio KePROOmniCarePartnership for PreventionPennsylvania Health Care Cost Containment CouncilPfizer

Physician Consortium for Performance Improvement

Press, Ganey AssociatesProfessional Research ConsultantsProHealth CareQualidigmResearch!AmericaRoswell Park Cancer InstituteSanofi-SynthélaboSelect Quality CareSociety for Healthcare Epidemiology of AmericaSolucientTexas Medical Institute of TechnologyUniform Data System for Medical RehabilitationUnited Hospital FundUniversity of North Carolina-Program on

Health OutcomesURACUS Food and Drug AdministrationUS PharmacopeiaVirginia Cardiac Surgery Quality InitiativeVirginia Health Quality CenterWest Virginia Medical InstituteWisconsin Collaborative for Healthcare Quality

Board of Directors**Gail L. Warden (Chair)

President EmeritusHenry Ford Health SystemDetroit, MI

William L. Roper, MD, MPH (Vice-Chair, Chair-Elect)1

Chief Executive OfficerUniversity of North Carolina Health Care SystemChapel Hill, NC

John C. Rother, JD (Vice-Chair)2

Director of Policy and StrategyAARPWashington, DC

John O. Agwunobi, MD, MBASecretaryFlorida Department of HealthTallahassee, FL

Harris A. Berman, MDDeanPublic Health and Professional Degree ProgramsTufts University School of MedicineBoston, MA

Dan G. Blair 3

Acting DirectorOffice of Personnel ManagementWashington, DC

Bruce E. BradleyDirector, Managed Care PlansGeneral Motors CorporationDetroit, MI

Carolyn M. Clancy, MDDirectorAgency for Healthcare Research and QualityRockville, MD

Nancy-Ann Min DeParle, Esq.4

Senior AdvisorJPMorgan PartnersWashington, DC

William E. Golden, MD5

Immediate Past PresidentAmerican Health Quality AssociationWashington, DC

Lisa I. Iezzoni, MD6

Professor of MedicineHarvard Medical SchoolBoston, MA

Kay Coles James7

DirectorOffice of Personnel ManagementWashington, DC

Mary B. Kennedy8

State Medicaid DirectorMinnesota Department of Human ServicesSt. Paul, MN

Kenneth W. Kizer, MD, MPHPresident and Chief Executive OfficerNational Quality ForumWashington, DC

Norma M. Lang, PhD, RNLillian S. Brunner Professor of Medical Surgical

NursingUniversity of PennsylvaniaPhiladelphia, PA

Brian W. Lindberg Executive DirectorConsumer Coalition for Quality Health Care Washington, DC

Mark B. McClellan, MD, PhD 9

AdministratorCenters for Medicare and Medicaid ServicesWashington, DC

B-4 NATIONAL QUALITY FORUM

Debra L. NessExecutive Vice PresidentNational Partnership for Women and FamiliesWashington, DC

Janet Olszewski10

DirectorMichigan Department of Community HealthLansing, MI

Paul H. O’NeillPittsburgh, PA

Christopher J. QueramChief Executive OfficerEmployer Health Care Alliance CooperativeMadison, WI

Jeffrey B. Rich, MD11

ChairVirginia Cardiac Surgery Quality InitiativeNorfolk, VA

Thomas A. Scully12

AdministratorCenters for Medicare and Medicaid ServicesWashington, DC

Gerald M. SheaAssistant to the President for Government AffairsAFL-CIOWashington, DC

Dennis G. Smith13

Acting AdministratorCenters for Medicare & Medicaid ServicesWashington, DC

Janet Sullivan, MD Chief Medical OfficerHudson Health PlanTarrytown, NY

James W. VarnumPresidentDartmouth-Hitchcock AllianceLebanon, NH

Marina L. Weiss, PhDSenior Vice President for Public Policy and

Government AffairsMarch of DimesWashington, DC

Dale Whitney 14

Corporate Health Care DirectorUPSAtlanta, GA

Liaison MembersYank D. Coble, Jr., MD15

Immediate Past President American Medical Association Chicago, IL

Janet M. Corrigan, PhDDirector Board on Health Care ServicesInstitute of Medicine Washington, DC

David J. Lansky 16

President Foundation for Accountability Portland, OR

Nancy H. Nielsen, MD, PhD17

Speaker, House of Delegates AMA for Physician Consortium for Performance

Improvement Chicago, IL

Margaret E. O’Kane President National Committee for Quality Assurance Washington, DC

Dennis S. O’Leary, MD President Joint Commission on Accreditation of Healthcare

Organizations Oakbrook Terrace, IL

Elias A. Zerhouni, MD Director National Institutes of Health Bethesda, MD

NATIONAL VOLUNTARY CONSENSUS STANDARDS FOR HOME HEALTH CARE: A CONSENSUS REPORT B-5

** During project period1 Resigned from Board of

Directors in February2004; renamed to Board of Directors and named Chair-Elect in May 2005

2 Vice-Chair sinceNovember 2004

3 Since February 20054 Since May 20045 Through December 20046 Through February 2005

7 Through January 20058 Through November 20049 Since April 200410 Since January 200511 Since January 200512 Through December 200313 Through March 200414 Since February 200415 Through May 200416 Through September 200417 Since June 2004

C-1


Steering CommitteeKathleen E. Chavanu, MSN, RN (Co-Chair)

Children’s National Medical CenterWashington, DC

Charles Sabatino, Esq. (Co-Chair)American Bar Association,

Commission on Law and AgingWashington, DC

Margaret Berkhousen, RN, BATrinity Home Health ServicesFarmington Hills, MI

Stephen R. Connor, PhDNational Hospice and Palliative Care

OrganizationAlexandria, VA

Penny Feldman, PhDVisiting Nurse Service of New YorkNew York, NY

Christie L. Franklin, RNAseraCareFort Smith, AR

Jon D. Fuller, MDVA Palo Alto Health Care SystemPalo Alto, CA

Sally Kozak, RNDepartment of Public Welfare/Office

of Medical Assistance ProgramsHarrisburg, PA

Katie Maslow, MSWAlzheimer’s AssociationWashington, DC

Cathy S. MeckesCareLinkQuincy, IL

Lynn V. Mitchell, MD, MPHOklahoma Healthcare AuthorityOklahoma City, OK

Maryanne L. Popovich, RN, MPHJoint Commission on Accreditation

of Healthcare OrganizationsOakbrook Terrace, IL

John C. Rother, JDAARPWashington, DC

Liaison MembersLisa Hines, MS, BSN

Centers for Medicare and MedicaidServices

Baltimore, MD

Karen Pace, PhD, RNDelmarva Foundation for

Medical CareEaston, MD

Debra Saliba, MD, MPHVeterans Affairs Health Services

Research and DevelopmentService/RAND Health

Los Angeles, CA

Robert E. Schlenker, PhDUniversity of Colorado Health

Sciences CenterAurora, CO

Teresa Twilley, RN, MSHome Health Corporation of AmericaSalisbury, MD

Appendix C

Steering Committee and Project Staff

C-2 NATIONAL QUALITY FORUM

Project StaffKenneth W. Kizer, MD, MPH

President and Chief Executive Officer

Robyn Y. Nishimi, PhDChief Operating Officer

Ellen T. Kurtzman, RN, MPHSenior Program Director

Dianne Feeney, BSN, MSVice President

Christine M. Page-LopezResearch Assistant

Melinda L. Murphy, RN, MS, CNASenior Vice President

Elaine J. Power, MPPVice President, Programs

Lawrence D. Gorban, MAVice President, Operations

Philip Dunn, MSJVice President, Communications and Public Affairs

Merilyn D. Francis, RN, MPPAssistant Vice President

Tammy P. McBride, RN, BSN Senior Program Director

Rodger J. Winn, MDClinical Consultant

Erika B. Wolter, MBA, MPH Research Assistant

Sabrina ZadroznyResearch Assistant

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