INTRODUCTION

In 1993 the National Association for Home Care Board of Directors charged the Information Resources and Quality Assurance Committee with the task of developing standardized definitions for home care and hospice data elements through a consensus conference process. The Board recognized this as a necessary first step toward achieving standardized, comparable home care and hospice data. The consensus conference was held in December 1993.

The following data set is the result of that conference and periodic revisions based on recommendations made to the Information Resources and Quality Assurance Committee.

Consensus conference participants agreed that the purpose in defining a data set is to facilitate data collection that will be comparable across agencies, geographic regions, and time. Some of the reasons for collecting data include:

1. Describing home care and hospice services, including the patients/clients and providers
2. Analyzing home care and hospice utilization and costs
3. Analyzing the effectiveness and quality of home and hospice care
4. Analyzing the business and financial aspects of home care and hospice

The framework adopted to guide development of the data set was based on the Department of Health and Human Services' concept of a uniform minimum data set. A uniform minimum data set for home care and hospice is a minimum set of items of information with uniform definitions and categories, concerning the specific dimension of home care and hospice services, that meets the essential information needs of multiple data users in the health care system.

The uniform data set (UDS) is intended to meet the common data needs of multiple users and will not necessarily meet the total data needs of any one organization. It also does not limit additional data collection by an organization to meet its specific information needs.

Criteria agreed upon for selecting data items and definitions included:

1. Demonstrated utility for multiple users
2. Relevance to national as well as local, state, or regional needs
3. Reasonable ease, accuracy, and economy in collection
4. "Need to know," not just "nice to know," information
5. Ability to be defined and measured
6. Use of the most common existing language, whenever possible
7. Uniformity with other applicable data sets
8. Ability to be coded for computer processing

The conference participants also affirmed that establishing a minimum data set is only the first step in achieving uniform data. Home care agencies, hospices, and data collectors must be encouraged to adopt it and a process must be established to refine the data set as users identify needed revisions. Home care and hospice providers are encouraged to make recommendations to the Committee using the format indicated at the end of this document.

The data set is organized into two major categories of organizational and individual level data elements. On an organizational level, the data set includes items that describe the organization, its services, and its aggregate utilization, financial and personnel data. On the individual level, items include demographic, clinical, service, and utilization data for patients/clients.

In 1997 the Information Resources and Quality Assurance Committee added the OASIS data set to the UDS. The committee recognizes that the demonstration on using OASIS for outcome-based quality improvement is still ongoing and therefore has not yet incorporated the outcome measures into the UDS. For now, the OASIS items are included as standardized definitions to describe home care patients.

This data set will be used as the basis for future data collection efforts by the National Association for Home Care. Other entities involved in home care and hospice data are also encouraged to use these definitions when constructing surveys and questionnaires.

The data elements are numbered consecutively. The terms that are not considered data elements but required standard definitions are numbered separately and preceded by T.

ORGANIZATIONAL LEVEL DATA

This section identifies the organizational level data elements that describe and categorize various types of home care organizations and services.

T1

Term: Home Care Organization

Definition: Broadly defined as the operational unit that provides one or more of the home care programs listed below to individuals in their residence. Staffing agencies or Durable Medical Equipment (DME) companies are not included.

Comment: The data set is for home care services rather than equipment or staffing registries.

1

Data Element Name: Type of Home Care Programs

Definition: Major classification of home care programs:

Home health care: professional services provided in the place of residence on either a part-time, intermittent, hourly, or shift basis

Hospice: organized program of interdisciplinary services for terminally ill patients and their families to provide palliative medical care and supportive social, emotional, and spiritual services in the place of residence

Support care: supportive services related to assistance with Instrumental Activities of Daily Living (IADL) provided on a part-time, intermittent, shift, or hourly basis in the place of residence

Personal care: personal care related to assistance with Activities of Daily Living (ADL) provided on a part-time, intermittent, hourly, or shift basis in the place of residence

Home infusion therapy: provision of both pharmaceuticals and skilled nursing services in the place of residence

Comment: Home care organizations may provide one or more home care programs.

2

Data Element Name: Ownership of Home Care Organization

Definition: The type of ownership of the home care organization:

Voluntary: governed by a community-based, voluntary board of directors

Private: non-profit or proprietary; privately owned and controlled by an individual, partnership, or corporation

Government (public, official): operated by a government entity (state, city, county, federal)

Combination Government/Voluntary: combination of government and voluntary control within one organization

Publicly held company: Company that issues stocks that are traded on a stock exchange.

Comment: The title Visiting Nurse Association/Service no longer exclusively designates a voluntary organization.

3

Data Element Name: Control of the Home Care Organization

Definition: Relationship of the home care organization to the controlling organization:

Sole corporation: independently incorporated and controlled; not a division, department, or subsidiary of a larger organization

Chain affiliate: freestanding health care facility that is either owned, controlled, or operated under lease or contract (franchise) by an organization consisting of two or more freestanding health care facilities organized within or across state lines that is under the ownership, or through any other device, control and direction of a common party

Wholly owned or subsidiary corporation: organization owned by another corporation such as a hospital or health system

Hospital-based: organized as a department/division of a hospital

Nursing facility-based: organized as a department/division of a nursing facility

Rehab-based: organized as a department/division of a rehab facility

HMO-based: organized as a department/division of an HMO

Health Department-based: organized as a department/division of a public health department

Comment: Organizations owned by a hospital but not organized as a department are not hospital-based.

4

Data Element: Controlling Organization

Definition: The entity that owns and controls a home care organization:

No separate controlling organization

Hospital

National company

Nursing home

Other institution

Health department

Health plan

Health system

Other

5

Data Element Name: Profit Status

Definition: Disposition of excess revenue over expenses:

Not-for-profit: excess revenue retained by the corporation; exempt from Federal income taxation under section 501 of the Internal Revenue Code of 1954

Proprietary (for profit): excess revenue distributed to owners or shareholders or held as retained earnings, subject to federal taxation

6

Data Element Name: Number of Branches

Definition: Total number of locations providing services to patients/clients under the control of the home care organization.

7

Data Element Name: Services

Definition: Care provided by or under the direction of specific disciplines offered by the home care organization:

Nursing (RN, LPN, LVN)

Home Care Aide (3 levels: environmental, personal care, medically directed services)

Physical therapy

Occupational therapy

Speech-language pathology

Social service

Respiratory therapy

Dietitian service

Pastoral care

Volunteer

Physician care

Dental care

Pharmacy

Other

Expressive therapy (art, music)

8

Data Element Name: Programs

Definition: Organization of single or multiple services for a designated population with specific care needs:

AIDS

Cardiopulmonary

Case management

Diabetic

Enterostomal therapy

Geriatrics

Hospice

Infusion therapy

Maternal/Child

Oncology

Pediatric

Psychiatric/Mental health

Rehab

Respite care

Other

9

Data Element Name: Certification

Definition: Required approval to provide services reimbursed by Medicare and/or Medicaid:

1) home health agency Medicare certification, 2) hospice Medicare certification, 3) home health agency Medicaid certification, 4) hospice Medicaid certification.

10

Data Element Name: Licensure

Definition: Required approval granted by a state to operate a home care organization: 1) home care agency licensure, 2) hospice licensure, 3) other licensure, 4) not required.

11

Data Element Name: Accreditation

Definition: Voluntary process of obtaining approval by demonstrating compliance with nonregulatory standards:

1) Community Health Accreditation Program (CHAP), 2) Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 3) National HomeCaring Council, 4) other.

12

Data Element Name: Service Area

Definition: Geographic areas served by all branches of the home care organization by zip codes including partial zip code areas.

13

Data Element Name: Unduplicated Patient/Client Census

Definition: Number of individuals receiving service from an organization during a given period of time counted only once, regardless of the number of services, frequency of admission, or payor source.

14

Data Element Name: Duplicated Patient/Client Census

Definition: The total number of admissions during a given period of time regardless of the number of individuals involved.

Comment: For example, the same individual admitted more than once during a reporting period would be counted each time admitted.

15

Data Element Name: Number of Non-Admissions

Definition: Total number of patient/client referrals during a given period of time for which the organization intended to provide service based on a request for service but patient/client not admitted to the organization for the following reasons:

1) moved/unable to locate, 2) refused services, 3) deceased, 4) admitted to hospital, 5) admitted to nursing home, 6) patient/client being seen by another home care organization, 7) patient/client does not meet organization admission criteria, 8) other.

This section identifies organizational level data elements for recording financial aspects of home care services.

16

Data Element Name: Gross Revenue

Definition: All billable charges for services and products at the full billable rate (prior to taking discounts or allowances).

Comment: Charity care should NOT be included in gross revenue calculations.

17

Data Element Name: Net Revenue

Definition: Gross revenue less all discounts or allowances (expected amount due from payor).

18

Data Element Name: Other Revenue

Definition: Nonservice and nonproduct related revenue.

Comment: For example, this may include interest, donations, charitable contributions, community support.

19

Data Element Name: Bad Debt Expense

Definition: The expense for the estimated amount of net revenue that is uncollectible.

Comment: Charity care is NOT considered a bad debt expense.

20

Data Element Name: Charity Care (Indigent Care)

Definition: Total charge of services and products based on full billable rate provided for clients identified on admission as a charity case, or after admission based on client's inability to pay.

Comments: Charity care should NOT be included in gross and net revenue calculations. Charity care is NOT considered a bad debt expense.

21

Data Element Name: Total Payroll Costs

Definition: Salary and wages paid to all employees.

22

Data Element Name: Contractor Expense

Definition: Personnel costs associated with contractors and/or subcontractors providing patient/client services or substituting for job functions normally performed by an employee of the organization.

23

Data Element Name: Benefits and Payroll Tax Expense

Definition: The employer's portion of all benefits and payroll taxes

Comment: Typically, this includes benefits to the individual, not the employer and organization (e.g., insurance, health care, etc.).

24

Data Element Name: Total Personnel Expense

Definition: The sum of total payroll costs, benefits and payroll tax expense, and contractor expense.

25

Data Element Name: Total Expense

Definition: The sum of all expenses.

26

Data Element Name: Annual Capital Expenditures

Definition: Expenditures for items to be depreciated with a minimum threshold of $500 and a service life of three years or more, including capitalized leases.

27

Data Element Name: Gross Accounts Receivable

Definition: The amount of gross charges for which payment has not yet been received.

28

Data Element Name: Net Accounts Receivable

Definition: Amount of net revenue for which payment has not been received minus an allowance for bad debt.

29

Data Element Name: Days Sales Outstanding

Definition: Net accounts receivable divided by (annual net revenue divided by 365)

=NAR/(ANR/365)

30

Data Element Name: Operating Income

Definition: Net revenue less total expenses excluding income taxes.

31

Data Element Name: Cost Per Unit of Service

Definition: Total expense for a service divided by total number of units of service provided.

32

Data Element Name: Charge

Definition: The published full billable rate by unit of service or product.

This section identifies organizational level data elements used to describe the home care work force.

T2

Term: Work Force Status

Definition: Working relationship with an organization:

Employee: individual under the supervision and control of the organization

Independent contractor: individual that meets the Internal Revenue Service criteria and for whom a W-2 form is not submitted

Subcontracted worker: individual providing services to an organization through a contractual relationship with another organization (subcontractor)

Volunteer: uncompensated individual directly under supervision and control of the organization

T3

Term: Pay Status

Definition: Method of payment to the work force:

Salary: Fixed base compensation paid regularly

Hourly: Compensation paid by the number of hours worked

Per-Visit: Compensation paid based on the number of visits made

Other: Per case, capitation, per fixed interval negotiated amount, and commission

33

Data Element Name: Number of Employees

Definition: Total number of employees working for the organization regardless of number of hours worked.

34

Data Element Name: Number of Independent Contractors

Definition: Total number of independent contractors working for the organization.

35

Data Element Name: Number of Subcontracted Workers

Definition: Total number of individuals providing service to the organization through a contractual relationship with another organization (subcontractor).

Comment: The number of subcontracted workers may be too difficult to track but FTEs can be calculated based on hours or visits paid.

36

Data Element Name: Number of Volunteers

Definition: Total number of volunteers working for the organization.

37

Data Element Name: Number of FTE Employees (full-time equivalent)

Definition: The sum of annual paid hours for all employees divided by 2080 hours.

Comments: This sets the standard for reporting FTEs. It will not interfere with individual agency procedures. For per-visit employees, divide their number of visits by the average number of visits made by a full-time employee.

38

Data Element Name: Number of FTE Independent Contractors

Definition: The sum of annual paid hours for all independent contractors divided by 2080 hours.

Comment: For per-visit contractors, divide their number of visits by the average number of visits made by a full-time employee.

39

Data Element Name: Number of FTE Subcontracted Workers

Definition: The sum of annual paid hours for all subcontracted workers divided by 2080 hours.

Comment: For per-visit subcontracted workers, divide their number of visits by the average number of visits made by a full-time employee.

40

Data Element Name: Number of FTE Volunteers

Definition: The sum of annual worked hours by all volunteers divided by 2080 hours.

T4

Term: Clinical Personnel

Definition: Those workers performing job functions having direct face-to-face patient/client contact:

RN: Registered nurse

Advanced Practice Registered Nurse: RN with Master's level education or special certification or Nurse Practitioner

LPN/LVN: Licensed practical/vocational nurse

Home Care Aide: I: environmental; II: personal care; III: medically directed services

PT: Physical therapist

PTA: Physical therapy assistant

OT: Occupational therapist

COTA: Certified occupational therapy assistant

SLP: Speech-language pathologist

MSW: Master's prepared social worker

BSW: Bachelor's prepared social worker

RT: Respiratory therapist

RD: Registered dietitian

Chaplain/Pastoral Care Worker

Physician

Bereavement counselor

Expressive therapist: (Art therapist, Music therapist)

Pharmacist

Comment: The source of the Home Care Aide I, II, III designations is the Home Care Aide Association of America's position statement "National Uniformity for Paraprofessional Title, Qualifications, and Supervision" (March, 1993).

T5

Term: Clinical Support Personnel

Definition: Those workers performing job functions providing direct support to the clinical personnel (e.g., QA, records, supplies, intake, education, clerical, clinical supervision).

T6

Term: Administrative Personnel

Definition: Those workers performing job functions having administrative responsibility for, and providing direction to, the organization (e.g., executives, chief officers, directors).

T7

Term: Administrative Support Personnel

Definition: Those workers performing job functions providing support to the administrative personnel or the entire organization (e.g., facilities services, clerical, reception, accounting, information systems, human resources, middle management/supervision).

41

Data Element Name: Total Number of FTEs by Personnel Category

Definition: The total number of FTEs for all workers for each personnel category: clinical, clinical support, administrative, and administrative support.

42

Data Element Name: Productivity

Definition: The average number of visits (or patient contact hours) for hourly or salaried workers per 8-hour day per discipline. [Total number of visits made (or hours of service) during a given period of time by hourly and salaried workers] divided by (paid hours minus vacation/holiday/sick days) multiplied by (8).

=(Total Visits (T11) per discipline / Paid Hours - (vac, hol, sick) per discipline) x 8

=(Direct Contact Hours per discipline / Paid Hours - (vac, hol, sick) per discipline) x 8

Comment: Vacation, holiday and sick days are deducted to eliminate differences based on different benefit packages. Productivity for per-visit employees cannot be calculated without accurate time records.

This section includes those individual level data items that should be recorded in the home care record and can be abstracted for data collection.

T8

Term: Patient/Client

Definition: Individual receiving home care services.

43

Data Element Name: Personal Identification

Definition: The unique number assigned to each patient/client that distinguishes the patient/client from all others.

Comments: Use of the same unique personal identifier as adopted with national health care reform is recommended. This number must only be used in accordance with confidentiality laws/privacy acts.

44

Data Element Name: Date of Birth

Definition: Month, day, year of birth, recorded MM/DD/YYYY.

45

Data Element Name: Race

Definition: As identified by the patient/client: 1) White, 2) Black, 3) American Indian or Alaskan Native, 4) Asian or Pacific Islander, 5) other, and 6) not identified.

Comment: This is in conformance with the United States Census Bureau categorization.

46

Data Element Name: Ethnicity

Definition: As identified by the patient/client: 1) Hispanic origin, 2) Non-Hispanic origin, 3) not identified.

Comment: This is in conformance with the United States Census Bureau categorization.

47

Data Element Name: Sex

Definition: Gender, as defined by male or female.

48

Data Element Name: Location of Residence

Definition: Zip code of dwelling where patient/client usually receives home care services.

49

Data Element Name: Type of Residence

Definition: Type of residence categorized as: 1) residence that does not provide formal support, 2) residential facility with staff that does provide formal support, 3) SNF (skilled nursing facility), 4) no permanent residence.

50

Data Element Name: Living Arrangements

Definition: Presence of others in the residence indicated by: 1) lives alone, 2) lives with others.

51

Data Element Name: Caregiver Availability

Definition: Availability of caregiver who accepts responsibility for patient's/client's well-being as defined by the following categories: 1) none needed, 2) needed/partially available, 3) needed/fully available, 4) needed/not available.

52

Data Element Name: Caregiver

Definition: The classification of the person(s) who accept(s) responsibility for the patient's/client's well being: 1) self, 2) relative, 3) friend/neighbor, 4) privately employed caregiver, 5) facility/residence staff, 6) legal representative, 7) other.

53

Data Element Name: Preadmission Location

Definition: The location of the patient/client in any of the following sites during the five days prior to admission to the home care organization: 1) home, 2) acute inpatient hospital, 3) skilled nursing facility, 4) rehabilitation facility, 5) assisted living facility, 6) board and care residence, 7) outpatient surgery center, 8) other.

Comment: The number of days prior to admission needs to be examined further.

54

Data Element Name: Medical Diagnosis

Definition: Any medical diagnoses that affect the care provided by the home care organization as defined by ICD-CM codes:

Principal: the diagnosis most responsible for the admission of the patient/client for home care service

Other: all other diagnoses that affect the care provided by the home care organization

Not applicable: if the home care services are not related to health care needs (e.g., homemaker)

55

Data Element Name: Surgical Procedures

Definition: Any surgical procedure that affects the care provided by the home care organization as defined by ICD-CM or CPT codes.

56

Data Element Name: Functional Status

Definition: Description of the individual's ability to perform activities of daily living and instrumental activities of daily living.

Comment: Need to decide on what measures to use. Some suggested sources are: Katz, Uniform Needs Assessment, Long-Term Health Care Data Set, Nursing Home Resident Assessment Data Set, Outcome Assessment Item Set (OASIS), Functional Independence Measure (FIM), Karnofsky Performance Scale.

57

Data Element Name: Patient/Client Problem

Definition: Clinical judgement made by professional health care personnel about a human response to an actual or potential health problem.

Comment: Possible approaches are: Omaha system, Home Health Care Classification (HHCC), North America Nursing Diagnosis Association (NANDA).

58

Data Element Name: Patient/Client Classification

Definition: Indicator of intensity of services.

Comments: Standard system not yet identified. Consider use of other indicators, such as stability on admission, number of meds, etc.

59

Data Element Name: Intervention

Definition: An action intended to benefit the patient/client in one of four categories: assess/evaluate, care, teach, and manage.

Comment: Possible approaches are: Medicare treatment codes, Omaha system, HHCC, Nursing Intervention Classification (NIC), care requirement categories from Uniform Needs Assessment.

60

Data Element Name: Outcome

Definition: A change in patient health status between two or more time points.

Comment: Health status encompasses physiologic, functional, cognitive, emotional, palliative and behavioral health. Outcomes may also address psychosocial factors related to the patient/family unit.

61

Data Element Name: Discharge Status

Definition: Change in overall condition of patient/client at time of discharge from the organization: recovered, stabilized, deteriorated, died (in home, hospital, or other setting).

62

Data Element Name: Provider Identification

Definition: The unique number assigned to each provider organization.

Comment: The ID number should be the same as the one assigned under national health care reform.

63

Data Element Name: Admission Date

Definition: Date the patient/client is accepted for service per episode by the home care organization.

Comment: The referral date or first billable visit may or may not coincide with the admission date.

64

Data Element Name: Discharge Date

Definition: Date when the home care organization is no longer responsible for patient/client services per episode.

Comment: For reporting purposes, patients are considered discharged if admitted to hospital greater than 48 hours. However, organizations may continue their own policies regarding paperwork when home care services are resumed after a hospitalization. This does not apply to hospice patients where the hospice is responsible for both inpatient and home care services.

T9

Term: Episode of Care

Definition: A discrete period of time starting with the admission date and ending with the discharge date during which home care is provided to the patient/client.

T10

Term: Length of stay

Definition: Total continuous days of service from admission to discharge including both the admission and discharge days.

Comment: This can be calculated from admission and discharge dates so it does not need to be a separate data element.

65

Data Element Name: Discharge Reason

Definition: The primary reason for discontinuing services:

patient/client no longer needs service

admitted to institution

death

moved from service area

unable to locate patient/client

patient/client requests discharge or revocation of hospice election

physician requests discharge

patient/client unwilling to participate in treatment plan

unsafe for staff

unsafe for patient/client

organization unable to provide level/mix of services needed

does not meet reimbursement criteria and patient fails to elect private pay

other

not applicable

66

Data Element Name: Discharge Disposition

Definition: Primary source of care after discharge from organization: 1) self, 2) family, 3) acute in-patient hospital, 4) skilled nursing facility, 5) residence that provides formal support, 6) hospice/other hospice, 7) home care/other home care organization (except hospice), 8) other, 9) not applicable.

67

Data Element Name: Expected Payor

Definition: Payor expected to be responsible for paying for services. Payors are defined as:

Primary: the person or entity that has the first responsibility for paying for services rendered

Secondary: additional parties responsible for paying a portion or all of the remaining charges

Common payors include:

Medicare

Medicaid

Private Insurance: any insurance system funded by employer and/or individuals including fee-for-service and managed care plans

Title III: Older Americans Act

Title XX: Social Service Block Grant

Other government funded programs: CHAMPUS, VA, IHS

Workers' compensation

County/state/local: nonfederal government funding

Self-pay (private pay): patient/client or other private party pays for services out-of-pocket (full fee or sliding scale)

Charity (indigent care): specific funds designated to pay for care of patients that meet established eligibility criteria, e.g., United Way, etc.

Other

T11

Term: Unit of Service-Visit

Definition: Direct face-to-face contact with a patient/client for the purpose of delivering service measured in visits regardless of length of time of visit.

T12

Term: Unit of Service-Hour

Definition: Direct face-to-face contact with a patient/client for the purpose of delivering service measured in hours (in quarter hour increments).

T13

Term: Care Coordination

Definition: Contact with patient/client, family, significant other, and any number of providers of service other than by direct patient contact in order to coordinate the plan of care. Contacts are measured in time by quarter hour increments.

Comment: Some examples include contact with: physician, equipment company, lab, payor, and conferences.

68

Data Element Name: Units of Service per Discipline

Definition: Total number of units of service (visits or hours) per discipline from admission to discharge.

69

Data Element Name: Number of Days per Level of Hospice Care

Definition: Level of hospice care measured in days. There are four levels of care: 1) routine home care, 2) continuous home care, 3) inpatient respite care, 4) general inpatient care.

The Outcome and ASsessment Information Set (OASIS) that HCFA is proposing for purposes of outcome-based quality improvement under Medicare (as part of the new Conditions of Participation)¹ has undergone several years of development and refinement. The first version was published in August 1995 as OASIS-A. This publication contains the second, refined version, namely OASIS-B. In addition to reviewing the purpose and evolution of the OASIS to date, this prologue provides information on operational issues such as whether the OASIS should be expected to increase or decrease time required for visits and documentation.

Purpose, History, and Improvements

The data items that constitute the OASIS were developed largely for purposes of measuring patient outcomes in home health care. Nearly all of the items also are useful for assessing the care needs of patients, but no pretense is made that the OASIS constitutes a comprehensive assessment instrument. Since the vast majority of OASIS items are similar to those currently used by most home health agencies at start of care (often in less precise form), it can be useful for home care agencies and others to replace their current versions of these items with the actual OASIS items. Experience in demonstration programs has shown that this not only facilitates gaining experience with OASIS, but it also enables home care providers to conduct more precise assessments of patient conditions for these items.

The OASIS has its genesis in a five-year national research program to develop outcome measures for home care (funded by HCFA and the Robert Wood Johnson Foundation). One of the important products from this program was a 73-item data set required to measure outcomes, first published in a 1994 report written by the Center for Health Services and Policy Research (the Research Center) at the University of Colorado. This was expanded to a 79-item data set as a result of recommendations from a HCFA-convened task force of home care experts which reviewed the data set from the perspective of items judged essential for assessment. The Research Center revised and rearranged the 79-items into a data set termed OASIS-A in 1995.

The OASIS-A items that had been developed and tested in the national research program (along with those added by the expert panel) were then used operationally in two demonstration programs (summarized below) in late 1995 and 1996. This experience suggested selected refinements, resulting in OASIS-B which contains 79 items. Although a few items were dropped, a few were added, and wording changes were made to clarify items, the substance of OASIS-B is virtually the same as OASIS-A. This publication contains OASIS-B, including the 79 core items preceded by 10 routine identifiers (termed clinical record items) that have proved useful in tracking, managing, and organizing data collection and processing. We had many requests for such identifiers after the release of OASIS-A in August 1995 and therefore include them here for agency use. As the Medicare program moves forward with OASIS, it is clear such identifiers (also used for billing, care planning, etc., under Medicare) would naturally accompany the core OASIS items and be of value for agency-specific applications of OASIS.

Thus, OASIS-B is largely the result of applying and testing OASIS-A in 1996 in (1) the national demonstration of outcome-based quality improvement (OBQI) that HCFA is sponsoring and the University of Colorado Research Center is administering, and (2) an analogous OBQI demonstration in New York State that the Department of Health is sponsoring and the University of Colorado Research Center is administering. The experience of the 50 national demonstration agencies and the 22 New York State demonstration agencies in using the OASIS for purposes of collecting outcome data, as well as selected experiences of other agencies throughout the country which have elected to use the OASIS data set, were taken into consideration in the modest set of revisions that resulted in OASIS-B. Reliability testing, programmatic applications, and provider suggestions to improve OASIS will continue with a view toward improving the data set. Nonetheless, OASIS is now regarded as a stable data set that can be used in the context of patient assessment and outcome monitoring. At the same time we recognize that as home care practices, patient conditions, and policies change, it will be necessary to occasionally update and refine the data set. (As other revisions are released, the suffixes "C," "D," etc., will be used.)

Deliberations took place on whether it would be wise for the Research Center to release OASIS-A in August 1995, since it would be followed within an 18-month period of time by OASIS-B, and perhaps subsequently by OASIS-C (at a minimum). In keeping with its philosophy of establishing a partnership with the home health industry announced under its Home Health Initiative in 1994, HCFA staff determined it appropriate to provide the industry with each of these versions of the OASIS as they become available.² This is not only in keeping with a philosophy of open communication and sharing, but also should (1) be of value to home health providers in preparing for the expected Medicare approach to data collection required for purposes of monitoring outcomes, (2) assist providers in collecting more precise data for purposes of assessment, (3) allow providers to begin to fit the OASIS data items into the unique, often more comprehensive data set tailored to their agency's assessment approach -- depending on the types of cases admitted and approaches to assessment used by each agency, and (4) assist the industry and Medicare in continuing to use an important data set before HCFA finalizes and implements new Conditions of Participation, thereby facilitating refinement of the OASIS on a prospective basis.

It is our intent at the Research Center to provide the home care industry with regular updates on OBQI demonstrations, operational issues related to OBQI that are important to both individual agencies and Medicare, strengths and weaknesses associated with using the OASIS for various purposes, and other issues pertinent to smoothly and effectively implementing the OASIS data set in order to measure outcomes. We have used and will continue to use several different forums for these communications. Information related to operational features of the OASIS is summarized in subsequent paragraphs.

Operational Issues

With respect to understanding and using OASIS data items, several points are important to take into consideration. If an agency wishes to incorporate OASIS items into its assessment protocols, the items should be kept intact rather than modified. This almost always requires revising existing items in agency forms. We make this suggestion both because OASIS items are likely to be required by Medicare in their exact form and because uniformity of items is imperative for across-agency comparisons and benchmarking. The OASIS items have been arranged in a clinically meaningful sequence to facilitate incorporating them into current instruments, although it is not necessary to retain this sequence. We have written a set of guidelines, termed OASIS Basics, which is available from our Research Center (until another means of publishing this monograph is determined) for agencies to use in the process of implementing the OASIS.³ Each item in the data set includes a unique identifier (which consists of five characters [one letter and four numbers]). While these identifiers are not required for assessment and care planning, they assist in data entry for computerization and subsequent report preparation. We therefore recommend that they be retained.

Since the OASIS is used for measuring outcomes defined as change in health status between two or more time points, most data items are obtained at start of care and follow-up time points (i.e., every 60 days and discharge). Selected items are unique to either start of care or follow-up times. These are indicated as such on the OASIS. All OASIS items are intended to be completed through routine patient assessment approaches and collection of patient subjective and objective data. The items should not be used in the form of a patient interview for collecting data.

The first impression of the OASIS may be that it is a lengthy data set. However, its length cannot be attributed to new items that agencies presently do not use at assessment. Rather, it is due to the greater precision that characterizes many of the items. This precision helps for purposes of measuring outcomes and improving the accuracy of assessing health status. Considerable experience with agencies suggests that once staff are familiar with the OASIS and OASIS items are integrated into (not added onto) the clinical record, assessment takes at most five or ten minutes longer, usually less. If, after staff have acclimated to the OASIS, it requires more time than this, we have found it highly likely that either the OASIS was not properly implemented and integrated, previous initial assessments were not comprehensive, or individual care providers might benefit from additional orientation to conducting assessment in the home.

We have very recently conducted a time survey among OASIS users who have properly integrated OASIS items into their assessment process and record keeping approach. Owing to the timing of the release of the draft Conditions in the Federal Register, it was not possible to incorporate the results of this new study in that release on March 10, 1997. The study involved a matched control design. A survey was undertaken to determine whether use of the OASIS in and of itself requires additional data collection time. This is a challenging issue to address precisely because many agencies implement changes concurrently with integrating OASIS into their clinical records. Multiple changes therefore precluded a pre-OASIS, post-OASIS design. Consequently, a study-control comparative approach was employed, with telephone survey data collected from nurses in branches using OASIS and from nurses in branches not using OASIS -- in the same agencies. All respondents were "blinded" as to the purpose of the survey, and 58 providers from 11 participating agencies were interviewed. The providers had been using the OASIS for approximately eight months. Each provider (i.e., each OASIS user and each non-OASIS user) was asked to provide the time spent in the patient's home and time spent documenting outside the home for the start-of-care visit and the discharge visit, on average and for their most recent visit of each type.

The basic finding was that the OASIS does not increase the total visit and documentation time. The pattern of results proved similar for average and most-recent-visit times. Findings for the average time are summarized here. At start of care, no statistically significant differences were found, with OASIS users spending an average of eight additional minutes in the home, but 15 minutes less in documentation (the precision of the OASIS items often reduces documentation time). Total visit and documentation time for OASIS users at start of care was 154 minutes, compared with 161 minutes for non-OASIS users. There were no statistically significant differences at time of discharge, with both groups averaging the same amount of time in the home and OASIS users averaging one minute less in documentation outside the home. Total visit and documentation time at discharge was 67 minutes for OASIS users and 68 minutes for non-OASIS users.

Several software developers either have software available or are developing software that incorporates the OASIS into their electronic clinical record systems.⁴ In addition, stand-alone OASIS-specific software, not part of a more comprehensive electronic clinical record system, is under development for agencies that do not have or are not presently interested in a more comprehensive electronic clinical record system. This stand-alone software will enable an agency to computerize or enter OASIS data that have been recorded by clinicians using forms that integrate the exact OASIS items into the agency's assessment instrument. Regardless of whether an agency uses a comprehensive electronic clinical record system (e.g., possibly with laptops) or stand-alone software to specifically computerize OASIS items, it is important that the exact OASIS items are directly incorporated into the clinical record. Agencies should be certain that their software (1) can be efficiently updated with occasional changes that might occur in OASIS, and (2) provides the capability to extract OASIS items for purposes of transmission to a central source for outcome comparisons and benchmarking, as well as other agency internal applications that will naturally be of interest once OASIS data are computerized.

We have attempted to be as responsive as our resources permit to questions and issues raised by software vendors. It is apparent that a number of vendors are moving in the right direction, and we encourage agencies to be diligent in making certain that OASIS items are incorporated verbatim or in some form equivalent to how they appear in the OASIS. The items should be integrated into and not added onto the end of the assessment. Care providers should not have the option to carry the same OASIS data from start of care to follow up in describing or assessing patient health status (this often results in inaccurate follow-up data because providers are tempted to minimize their time by carrying forward the data from the initial time point instead of properly reassessing and recording the information at follow up). This carry-forward approach should not be used in either paper or electronic documentation approaches.

We have had considerable input from care providers in response to the OASIS. A few points are highlighted here. Some providers have suggested that more detail should accompany selected data items. For example, some physical therapists have noted that selected scales exist that provide more detail than the functional scales in the OASIS. In reviewing the many approaches to measuring health status in our research program, we found it necessary to strike a balance among competing objectives such as (1) minimizing the burden of data collection, (2) increasing the specificity of health status scales, (3) maximizing consistency among different individuals collecting the same information, and (4) rendering the data items as discipline-neutral as possible (i.e., individuals from one discipline should be able to provide information with the same accuracy and precision as those from another discipline). The data items in OASIS-B are the result of blending these competing priorities in an effort to produce a data set that is precise yet practical, and for the most part, reliable yet not overly burdensome.

Care providers have indicated that it may take four to six visits for a provider to become familiar and comfortable with using the OASIS, in much the same manner it takes to familiarize new staff with current forms or current staff with a change in assessment forms. We have also received a large number of comments on the utility of the increased precision of patient assessment that results from the OASIS. For example, care planning can be more specific, more precise documentation of patient condition facilitates communication with physicians, and the increased precision can be advantageous in justifying approaches to and quantities of service provision to managed care organizations.

We wish to repeat that the OASIS was not developed as a comprehensive assessment instrument. It was developed primarily for purposes of measuring outcomes for adult home care patients. Agencies will find it necessary to supplement the OASIS in order to comprehensively assess health status and care needs of patients (for example, the OASIS does not include vital signs, nor was it developed with pediatric patients in mind). The purpose in disseminating OASIS-B at the present time is to assist home care agencies and other providers in acclimating to these types of data items and to benefit from our collective experiences as we move toward a standardized data set under Medicare and other purchasers of home care services.

It is also important to note that the purpose of measuring patient outcomes through the OASIS is to assist home care agencies with quality improvement activities. In 995, we authored a book published by the National Association for Home Care, Outcome-Based Quality Improvement, a Manual for Home Care Agencies on How to Use Outcomes.⁵ This publication provides guidance to agencies on measuring and reporting outcomes, and using them to improve quality.

DEMOGRAPHICS AND PATIENT HISTORY

1. (M0100) This Assessment is Currently Being Completed for the Following Reason:

[ ] 1 - Start of care
[ ] 2 - Resumption of care (after inpatient stay)
[ ] 3 - Discharge from agency - not to an inpatient facility [ Go to M0150 ]
[ ] 4 - Transferred to an inpatient facility - discharged from agency [ Go to M0830 ]
[ ] 5 - Transferred to an inpatient facility - not discharged from agency [ Go to M0830 ]
[ ] 6 - Died at home [ Go to M0906 ]
[ ] 7 - Recertification reassessment (follow-up) [ Go to M0150 ]
[ ] 8 - Other follow-up [ Go to M0150 ]

2. (M0130) Gender:

[ ] 1 - Male
[ ] 2 - Female

3. (M0140) Race/Ethnicity (as identified by patient):

[ ] 1 - White, non-Hispanic
[ ] 2 - Black, African-American
[ ] 3 - Hispanic
[ ] 4 - Asian, Pacific Islander
[ ] 5 - American Indian, Eskimo, Aleut
[ ] 6 - Other (r) UK - Unknown

4. (M0150) Current Payment Sources for Home Care: (Mark all that apply.)

[ ] 0 - None; no charge for current services
[ ] 1 - Medicare (traditionalfee-for-service)
[ ] 2 - Medicare (HMO/managed care)
[ ] 3 - Medicaid (traditionalfee-for-service)
[ ] 4 - Medicaid (HMO/managed care)
[ ] 5 - Workers' compensation
[ ] 6 - Title programs (e.g., Title III, V, or XX)
[ ] 7 - Other government (e.g.,CHAMPUS, VA, etc.)
[ ] 8 - Private insurance
[ ] 9 - Private HMO/managed care
[ ] 10 - Self-pay
[ ] 11 - Other (specify)
[ ] UK - Unknown

5. (M0160) Financial Factors limiting the ability of the patient/family to meet basic health needs: (Mark all that apply.)

[ ] 0 - None
[ ] 1 - Unable to afford medicine or medical supplies
[ ] 2 - Unable to afford medical expenses that are not covered by insurance/Medicare (e.g., copayments)
[ ] 3 - Unable to afford rent/utility bills
[ ] 4 - Unable to afford food
[ ] 5 - Other (specify)

6. (M0170) From which of the following Inpatient Facilities was the patient discharged during the past 14 days? (Mark all that apply.)

[ ] 1 - Hospital
[ ] 2 - Rehabilitation facility
[ ] 3 - Nursing home
[ ] 4 - Other (specify)__________________________
[ ] NA - Patient was not discharged from an inpatient facility [ If NA, go to M0200 ]

7. (M0180) Inpatient Discharge Date (most recent):

__ __ /__ __ / __ __ __ __
month / day / year

[ ] UK - Unknown

8. (M0190) Inpatient Diagnoses and three-digit ICD code categories for only those conditions treated during an inpatient facility stay within the last 14 days (no surgical or V-codes):

9. (M0200) Medical or Treatment Regimen Change Within Past 14 Days: Has this patient experienced a change in medical or treatment regimen (e.g., medication, treatment, or service change due to new or additional diagnosis, etc.) within the last 14 days?

[ ] 0 - No [ If No, go to M0220 ]
[ ] 1 - Yes

10. (M0210) List the patient's Medical Diagnoses and three-digit ICD code categories for those conditions requiring changed medical or treatment regimen (no surgical or V-codes):

11. (M0220) Conditions Prior to Medical or Treatment Regimen Change or Inpatient Stay Within Past 14 Days: If this patient experienced an inpatient facility discharge or change in medical or treatment regimen within the past 14 days, indicate any conditions which existed prior to the inpatient stay or change in medical or treatment regimen. (Mark all that apply.)

[ ] 1 - Urinary incontinence
[ ] 2 - Indwelling/suprapubic catheter
[ ] 3 - Intractable pain
[ ] 4 - Impaired decision-making
[ ] 5 - Disruptive or socially inappropriate behavior
[ ] 6 - Memory loss to the extent that supervision required
[ ] 7 - None of the above
[ ] NA - No inpatient facility discharge and no change in medical or treatment regimen in past 14 days
[ ] UK - Unknown

12. (M0230/M0240)Diagnoses and Severity Index: List each medical diagnosis or problem for which the patient is receiving home care and ICD code category (no surgical or V-codes) and rate them using the following severity index. (Choose one value that represents the most severe rating appropriate for each diagnosis.)

0 - Asymptomatic, no treatment needed at this time
1 - Symptoms well controlled with current therapy
2 - Symptoms controlled with difficulty, affecting daily functioning; patient needs ongoing monitoring
3 - Symptoms poorly controlled, patient needs frequent adjustment intreatment and dose monitoring
4 - Symptoms poorly controlled, history of rehospitalizations

13. (M0250) Therapies the patient receives at home: (Mark all that apply.)

[ ] 1 - Intravenous or infusion therapy (excludes TPN)
[ ] 2 - Parenteral nutrition (TPN or lipids)
[ ] 3 - Enteral nutrition (nasogastric, gastrostomy, jejunostomy, or any other artificial entry into the alimentary canal)
[ ] 4 - None of the above

14. (M0260) Overall Prognosis: BEST description of patient's overall prognosis for recovery from this episode of illness.

[ ] 0 - Poor: little or no recovery is expected and/or further decline is imminent
[ ] 1 - Good/Fair: partial to full recovery is expected
[ ] UK - Unknown

15. (M0270) Rehabilitative Prognosis: BEST description of patient's prognosis for functional status.

[ ] 0 - Guarded: minimal improvement in functional status is expected; decline is possible
[ ] 1 - Good: marked improvement in functional status is expected
[ ] UK - Unknown

16. (M0280) Life Expectancy: (Physician documentation is not required.)

[ ] 0 - Life expectancy is greater than 6 months
[ ] 1 - Life expectancy is 6 months or fewer

17. (M0290) High Risk Factors characterizing this patient: (Mark all that apply.)

[ ] 1 - Heavy smoking
[ ] 2 - Obesity
[ ] 3 - Alcohol dependency
[ ] 4 - Drug dependency
[ ] 5 - None of the above
[ ] UK - Unknown

LIVING ARRANGEMENTS

18. (M0300) Current Residence:

[ ] 1 - Patient's owned or rented residence (house, apartment, or mobile home owned or rented by patient/couple/significant other)
[ ] 2 - Family member's residence
[ ] 3 - Boarding home or rented room
[ ] 4 - Board and care or assisted living facility
[ ] 5 - Other (specify) ____________________

19. (M0310) Structural Barriers in the patient's environment limiting independent mobility: (Mark all that apply.)

[ ] 0 - None
[ ] 1 - Stairs inside home which must be used by the patient (e.g., to get to toileting, sleeping, eating areas)
[ ] 2 - Stairs inside home which are used optionally (e.g., to get to laundry facilities)
[ ] 3 - Stairs leading from inside house to outside
[ ] 4 - Narrow or obstructed doorways

20. (M0320) Safety Hazards found in the patient's current place of residence: (Mark all that apply.)

[ ] 0 - None
[ ] 1 - Inadequate floor, roof, or windows
[ ] 2 - Inadequate lighting
[ ] 3 - Unsafe gas/electric appliance
[ ] 4 - Inadequate heating
[ ] 5 - Inadequate cooling
[ ] 6 - Lack of fire safety devices
[ ] 7 - Unsafe floor coverings
[ ] 8 - Inadequate stair railings
[ ] 9 - Improperly stored hazardous materials
[ ] 10 - Lead-based paint
[ ] 11 - Other (specify) ____________________

21. (M0330) Sanitation Hazards found in the patient's current place of residence: (Mark all that apply.)

[ ] 0 - None
[ ] 1 - No running water
[ ] 2 - Contaminated water
[ ] 3 - No toileting facilities
[ ] 4 - Outdoor toileting facilities only
[ ] 5 - Inadequate sewage disposal
[ ] 6 - Inadequate/improper food storage
[ ] 7 - No food refrigeration
[ ] 8 - No cooking facilities
[ ] 9 - Insects/rodents present
[ ] 10 - No scheduled trash pickup
[ ] 11 - Cluttered/soiled living area
[ ] 12 - Other (specify) ____________________

22. (M0340) Patient Lives With: (Mark all that apply.)

[ ] 1 - Lives alone
[ ] 2 - With spouse or significant other
[ ] 3 - With other family member
[ ] 4 - With a friend
[ ] 5 - With paid help (other than home care agency staff)
[ ] 6 - With other than above

SUPPORTIVE ASSISTANCE

23. (M0350) Assisting Person(s) Other than Home Care Agency Staff: (Mark all that apply.)

[ ] 1 - Relatives, friends, or neighbors living outside the home
[ ] 2 - Person residing in the home (EXCLUDING paid help)
[ ] 3 - Paid help
[ ] 4 - None of the above [ If None of the above, go to M0390 ]
[ ] UK - Unknown [ If Unknown, go to M0390 ]

24. (M0360) Primary Caregiver taking lead responsibility for providing or managing the patient's care, providing the most frequent assistance, etc. (other than home care agency staff):

[ ] 0 - No one person [If No one person, go to M0390 ]
[ ] 1 - Spouse or significant other
[ ] 2 - Daughter or son
[ ] 3 - Other family member
[ ] 4 - Friend or neighbor or community or church member
[ ] 5 - Paid help
[ ] UK - Unknown [ If Unknown, go to M0390 ]

25. (M0370) How Often does the patient receive assistance from the primary caregiver?

[ ] 1 - Several times during day and night
[ ] 2 - Several times during day
[ ] 3 - Once daily
[ ] 4 - Three or more times per week
[ ] 5 - One to two times per week
[ ] 6 - Less often than weekly
[ ] UK - Unknown

26. (M0380) Type of Primary Caregiver Assistance: (Mark all that apply.)

[ ] 1 - ADL assistance (e.g., bathing, dressing, toileting, bowel/bladder, eating/feeding)
[ ] 2 - IADL assistance (e.g., meds, meals, housekeeping, laundry, telephone, shopping, finances)
[ ] 3 - Environmental support (housing, home maintenance)
[ ] 4 - Psychosocial support (socialization, companionship, recreation)
[ ] 5 - Advocates or facilitates patient's participation in appropriate medical care
[ ] 6 - Financial agent, power of attorney, or conservator of finance
[ ] 7 - Health care agent, conservator of person, or medical power of attorney
[ ] UK - Unknown

SENSORY STATUS

27. (M0390) Vision with corrective lenses if the patient usually wears them:

[ ] 0 - Normal vision: sees adequately in most situations; can see medication labels, newsprint.
[ ] 1 - Partially impaired: cannot see medication labels or newsprint, but can see obstacles in path, and the surrounding layout; can count fingers at arm's length.
[ ] 2 - Severely impaired: cannot locate objects without hearing or touching them or patient nonresponsive.

28. (M0400) Hearing and Ability to Understand Spoken Language in patient's own language (with hearing aids if the patient usually uses them):

[ ] 0 - No observable impairment. Able to hear and understand complex or detailed instructions and extended or abstract conversation.
[ ] 1 - With minimal difficulty, able to hear and understand most multi-step instructions and ordinary conversation. May need occasional repetition, extra time, or louder voice.
[ ] 2 - Has moderate difficulty hearing and understanding simple, one-step instructions and brief conversation; needs frequent prompting or assistance.
[ ] 3 - Has severe difficulty hearing and understanding simple greetings and short comments. Requires multiple repetitions, restatements, demonstrations, additional time.
[ ] 4 - Unable to hear and understand familiar words or common expressions consistently, or patient nonresponsive.

29. (M0410) Speech and Oral (Verbal) Expression of Language (in patient's own language):

[ ] 0 - Expresses complex ideas, feelings, and needs clearly, completely, and easily in all situations with no observable impairment.
[ ] 1 - Minimal difficulty in expressing ideas and needs (may take extra time; makes occasional errors in word choice, grammar or speech intelligibility; needs minimal prompting or assistance).
[ ] 2 - Expresses simple ideas or needs with moderate difficulty (needs prompting or assistance, errors in word choice, organization or speech intelligibility). Speaks in phrases or short sentences.
[ ] 3 - Has severe difficulty expressing basic ideas or needs and requires maximal assistance or guessing by listener. Speech limited to single words or short phrases.
[ ] 4 - Unable to express basic needs even with maximal prompting or assistance but is not comatose or unresponsive (e.g., speech is nonsensical or unintelligible).
[ ] 5 - Patient nonresponsive or unable to speak.

30. (M0420) Frequency of Pain interfering with patient's activity or movement:

[ ] 0 - Patient has no pain or pain does not interfere with activity or movement
[ ] 1 - Less often than daily
[ ] 2 - Daily, but not constantly
[ ] 3 - All of the time

31. (M0430) Intractable Pain: Is the patient experiencing pain that is not easily relieved, occurs at least daily, and affects the patient's sleep, appetite, physical or emotional energy, concentration, personal relationships, emotions, or ability or desire to perform physical activity?

[ ] 0 - No
[ ] 1 - Yes

INTEGUMENTARY STATUS

32. (M0440) Does this patient have a Skin Lesion or an Open Wound? This excludes "OSTOMIES."

[ ] 0 - No [ If No, go to M0490 ]
[ ] 1 - Yes

33. (M0445) Does this patient have a Pressure Ulcer?

[ ] 0 - No [ If No, go to M0468 ]
[ ] 1 - Yes

33a. (M0450) Current Number of Pressure Ulcers at Each Stage: (Circle one response for each stage.)

[ ] 1 - Stage 1
[ ] 2 - Stage 2
[ ] 3 - Stage 3
[ ] 4 - Stage 4
[ ] NA - No observable pressure ulcer

[ ] 1 - Fully granulating
[ ] 2 - Early/partial granulation
[ ] 3 - Not healing
[ ] NA - No observable pressure ulcer

34. (M0468) Does this patient have a Stasis Ulcer?

[ ] 0 - No [ If No, go to M0482 ]
[ ] 1 - Yes

[ ] 0 - Zero
[ ] 1 - One
[ ] 2 - Two
[ ] 3 - Three
[ ] 4 - Four or more

34b. (M0474) Does this patient have at least one Stasis Ulcer that Cannot be Observed due to the presence of a nonremovable dressing?

[ ] 0 - No
[ ] 1 - Yes

[ ] 1 - Fully granulating
[ ] 2 - Early/partial granulation
[ ] 3 - Not healing
[ ] NA - No observable stasis ulcer

35. (M0482) Does this patient have a Surgical Wound?

[ ] 0 - No [ If No, go to M0490 ]
[ ] 1 - Yes

35a. (M0484) Current Number of (Observable) Surgical Wounds: (If a wound is partially closed but has more than one opening, consider each opening as a separate wound.)

[ ] 0 - Zero
[ ] 1 - One
[ ] 2 - Two
[ ] 3 - Three
[ ] 4 - Four or more

35b. (M0486) Does this patient have at least one Surgical Wound that Cannot be Observed due to the presence of a nonremovable dressing?

[ ] 0 - No
[ ] 1 - Yes

35c. (M0488) Status of Most Problematic (Observable) Surgical Wound:

[ ] 1 - Fully granulating
[ ] 2 - Early/partial granulation
[ ] 3 - Not healing
[ ] NA - No observable surgical wound

RESPIRATORY STATUS

36. (M0490) When is the patient dyspneic or noticeably Short of Breath?

[ ] 0 - Never, patient is not short of breath
[ ] 1 - When walking more than 20 feet, climbing stairs
[ ] 2 - With moderate exertion (e.g., while dressing, using commode or bedpan, walking distances less than 20 feet)
[ ] 3 - With minimal exertion (e.g., while eating, talking, or performing other ADLs) or with agitation
[ ] 4 - At rest (during day or night)

37. (M0500) Respiratory Treatments utilized at home: (Mark all that apply.)

[ ] 1 - Oxygen (intermittent or continuous)
[ ] 2 - Ventilator (continually or at night)
[ ] 3 - Continuous positive airway pressure
[ ] 4 - None of the above

ELIMINATION STATUS

38. (M0510) Has this patient been treated for a Urinary Tract Infection in the past 14 days?

[ ] 0 - No
[ ] 1 - Yes
[ ] NA - Patient on prophylactic treatment
[ ] UK - Unknown

39. (M0520) Urinary Incontinence or Urinary Catheter Presence:

[ ] 0 - No incontinence or catheter (includes anuria or ostomy for urinary drainage) [ If No, go to M0540 ]
[ ] 1 - Patient is incontinent
[ ] 2 - Patient requires a urinary catheter (i.e., external, indwelling, intermittent, suprapubic) [ Go to M0540 ]

40. (M0530) When does Urinary Incontinence occur?

[ ] 0 - Timed-voiding defers incontinence
[ ] 1 - During the night only
[ ] 2 - During the day and night

41. (M0540) Bowel Incontinence Frequency:

[ ] 0 - Very rarely or never has bowel incontinence
[ ] 1 - Less than once weekly
[ ] 2 - One to three times weekly
[ ] 3 - Four to six times weekly
[ ] 4 - On a daily basis
[ ] 5 - More often than once daily
[ ] NA - Patient has ostomy for bowel elimination
[ ] UK - Unknown

42. (M0550) Ostomy for Bowel Elimination: Does this patient have an ostomy for bowel elimination that (within the last 14 days): a) was related to an inpatient facility stay, or b) necessitated achange in medical or treatment regimen?

[ ] 0 - Patient does not have an ostomy for bowel elimination.
[ ] 1 - Patient's ostomy was not related to an inpatient stay and did not necessitate change in medical or treatment regimen.
[ ] 2 - The ostomy was related to an inpatient stay or did necessitate change in medical or treatment regimen.

NEURO/EMOTIONAL/BEHAVIORAL STATUS

43. (M0560) Cognitive Functioning: (Patient's current level of alertness, orientation, comprehension, concentration, and immediate memory for simple commands.)

[ ] 0 - Alert/oriented, able to focus and shift attention, comprehends and recalls task directions independently.
[ ] 1 - Requires prompting (cuing, repetition, reminders) only under stressful or unfamiliar conditions.
[ ] 2 - Requires assistance and some direction in specific situations (e.g., on all tasks involving shifting of attention), or consistently requires low stimulus environment due to distractibility.
[ ] 3 - Requires considerable assistance in routine situations. Is not alert and oriented or is unable to shift attention and recall directions more than half the time.
[ ] 4 - Totally dependent due to disturbances such as constant disorientation, coma, persistent vegetative state, or delirium.

44. (M0570) When Confused (Reported or Observed):

[ ] 0 - Never
[ ] 1 - In new or complex situations only
[ ] 2 - On awakening or at night only
[ ] 3 - During the day and evening, but not constantly
[ ] 4 - Constantly
[ ] NA - Patient nonresponsive

45. (M0580) When Anxious (Reported or Observed):

[ ] 0 - None of the time
[ ] 1 - Less often than daily
[ ] 2 - Daily, but not constantly
[ ] 3 - All of the time
[ ] NA - Patient nonresponsive

46. (M0590) Depressive Feelings Reported or Observed in Patient: (Mark all that apply.)

[ ] 1 - Depressed mood (e.g., feeling sad, tearful)
[ ] 2 - Sense of failure or self reproach
[ ] 3 - Hopelessness
[ ] 4 - Recurrent thoughts of death
[ ] 5 - Thoughts of suicide
[ ] 6 - None of the above feelings observed or reported

47. (M0600) Patient Behaviors (Reported or Observed): (Mark all that apply.)

[ ] 1 - Indecisiveness, lack of concentration
[ ] 2 - Diminished interest in most activities
[ ] 3 - Sleep disturbances
[ ] 4 - Recent change in appetite or weight
[ ] 5 - Agitation
[ ] 6 - A suicide attempt
[ ] 7 - None of the above behaviors observed or reported

48. (M0610) Behaviors Demonstrated at Least Once a Week (Reported or Observed): (Mark all that apply.)

[ ] 1 - Memory deficit: failure to recognize familiar persons/places, inability to recall events of past 24 hours, significant memory loss so that supervision is required
[ ] 2 - Impaired decision-making: failure to perform usual ADLs or IADLs, inability to appropriately stop activities, jeopardizes safety through actions
[ ] 3 - Verbal disruption: yelling, threatening, excessive profanity, sexual references, etc.
[ ] 4 - Physical aggression: aggressive or combative to self and others (e.g., hits self, throws objects, punches, dangerous maneuvers with wheelchair or other objects)
[ ] 5 - Disruptive, infantile, or socially inappropriate behavior (excludes verbal actions)
[ ] 6 - Delusional, hallucinatory, or paranoid behavior
[ ] 7 - None of the above behaviors demonstrated

49. (M0620) Frequency of Behavior Problems (Reported or Observed) (e.g., wandering episodes, self abuse, verbal disruption, physical aggression, etc.):

[ ] 0 - Never
[ ] 1 - Less than once a month
[ ] 2 - Once a month
[ ] 3 - Several times each month
[ ] 4 - Several times a week
[ ] 5 - At least daily

50. (M0630) Is this patient receiving Psychiatric Nursing Services at home provided by a qualified psychiatric nurse?

[ ] 0 - No
[ ] 1 - Yes

ADL/IADLs

51. (M0640) Grooming: Ability to tend to personal hygiene needs (i.e., washing face and hands, hair care, shaving or make up, teeth or denture care, fingernail care).

52. (M0650) Ability to Dress Upper Body (with or without dressing aids) including undergarments, pullovers, front-opening shirts and blouses, managing zippers, buttons, and snaps:

53. (M0660) Ability to Dress Lower Body (with or without dressing aids) including undergarments, slacks, socks or nylons, shoes:

54. (M0670) Bathing: Ability to wash entire body. Excludes grooming (washing face and hands only).

55. (M0680) Toileting: Ability to get to and from the toilet or bedside commode.

56. (M0690) Transferring: Ability to move from bed to chair, on and off toilet or commode, into and out of tub or shower, and ability to turn and position self in bed if patient is bedfast.

57. (M0700) Ambulation/Locomotion: Ability to SAFELY walk, once in a standing position, or use a wheelchair, once in a seated position, on a variety of surfaces.

58. (M0710) Feeding or Eating: Ability to feed self meals and snacks. Note: This refers only to the process of eating, chewing, and swallowing, not preparing the food to be eaten.

59. (0720) Planning and Preparing Light Meals (e.g., cereal, sandwich) or reheat delivered meals:

60. (M0730) Transportation: Physical and mental ability to safely use a car, taxi, or public transportation (bus, train, subway).

61. (M0740) Laundry: Ability to do own laundry -- to carry laundry to and from washing machine, to use washer and dryer, to wash small items by hand.

62. (M0750) Housekeeping: Ability to safely and effectively perform light housekeeping and heavier cleaning tasks.

63. (M0760) Shopping: Ability to plan for, select, and purchase items in a store and to carry them home or arrange delivery.

64. (M0770)4 Ability to Use Telephone: Ability to answer the phone, dial numbers, and effectively use the telephone to communicate.

MEDICATIONS

65. (M0780) Management of Oral Medications: Patient's ability to prepare and take all prescribed oral medications reliably and safely, including administration of the correct dosage at the appropriate times/intervals. Excludes injectable and IV medications. (NOTE: This refers to ability, not compliance or willingness.)

66. (M0790) Management of Inhalant/Mist Medications: Patient's ability to prepare and take all prescribed inhalant/mist medications (nebulizers, metered dose devices) reliably and safely, including administration of the correct dosage at the appropriate times/intervals. Excludes all other forms of medication (oral tablets, injectable and IV medications).

67. (M0800) Management of Injectable Medications: Patient's ability to prepare and take all prescribed injectable medications reliably and safely, including administration of correct dosage at the appropriate times/intervals. Excludes IV medications.

EQUIPMENT MANAGEMENT

68. (M0810) Patient Management of Equipment (includes ONLY oxygen, IV/infusion therapy, enteral/parenteral nutrition equipment or supplies): Patient's ability to set up, monitor and change equipment reliably and safely, add appropriate fluids or medication, clean/store/dispose of equipment or supplies using proper technique. (NOTE: This refers to ability, not compliance or willingness.)

[ ] 0 - Patient manages all tasks related to equipment completely independently.
[ ] 1 - If someone else sets up equipment (i.e., fills portable oxygen tank, provides patient with prepared solutions), patient is able to manage all other aspects of equipment.
[ ] 2 - Patient requires considerable assistance from another person to manage equipment, but independently completes portions of the task.
[ ] 3 - Patient is only able to monitor equipment (e.g., liter flow, fluid in bag) and must call someone else to manage the equipment.
[ ] 4 - Patient is completely dependent on someone else to manage all equipment.
[ ] NA - No equipment of this type used in care [ If NA, go to M0830 ]

69. (M0820) Caregiver Management of Equipment (includes ONLY oxygen, IV/infusion equipment, enteral/parenteral nutrition, ventilator therapy equipment or supplies): Caregiver's ability to set up, monitor, and change equipment reliably and safely, add appropriate fluids or medication, clean/store/dispose of equipment or supplies using proper technique. (NOTE: This refers to ability, not compliance or willingness.)

[ ] 0 - Caregiver manages all tasks related to equipment completely independently.
[ ] 1 - If someone else sets up equipment, caregiver is able to manage all other aspects.
[ ] 2 - Caregiver requires considerable assistance from another person to manage equipment, but independently completes significant portions of task.
[ ] 3 - Caregiver is only able to complete small portions of task (e.g., administer nebulizer treatment, clean/store/dispose of equipment or supplies).
[ ] 4 - Caregiver is completely dependent on someone else to manage all equipment.
[ ] NA - No caregiver
[ ] UK - Unknown

EMERGENT CARE

70. (M0830) Emergent Care: Since the last time OASIS data were collected, has the patient utilized any of the following services for emergent care (other than home care agency services)? (Mark all that apply.)

[ ] 0 - No emergent care services [ If No emergent care and patient discharged, go to M0855]
[ ] 1 - Hospital emergency room (includes 23-hour holding)
[ ] 2 - Doctor's office emergency visit/house call
[ ] 3 - Outpatient department/clinic emergency (includes urgicenter sites)
[ ] UK - Unknown

71. (M0840) Emergent Care Reason: For what reason(s) did the patient/family seek emergent care? (Mark all that apply.)

[ ] 1 - Improper medication administration, medication side effects, toxicity, anaphylaxis
[ ] 2 - Nausea, dehydration, malnutrition, constipation, impaction
[ ] 3 - Injury caused by fall or accident at home
[ ] 4 - Respiratory problems (e.g., shortness of breath, respiratory infection, tracheobronchial obstruction)
[ ] 5 - Wound infection, deteriorating wound status, new lesion/ulcer
[ ] 6 - Cardiac problems (e.g., fluid overload, exacerbation of CHF, chest pain)
[ ] 7 - Hypo/Hyperglycemia, diabetes out of control
[ ] 8 - GI bleeding, obstruction
[ ] 9 - Other than above reasons
[ ] UK - Reason unknown

DATA ITEMS COLLECTED AT INPATIENT FACILITY ADMISSION OR AGENCY DISCHARGE ONLY

72. (M0855) To which Inpatient Facility has the patient been admitted?

[ ] 1 - Hospital [ Go to M0890 ]
[ ] 2 - Rehabilitation facility [ Go to M0903 ]
[ ] 3 - Nursing home [ Go to M0900 ]
[ ] 4 - Hospice [ Go to M0903 ]
[ ] NA - No inpatient facility admission

73. (M0870) Discharge Disposition: Where is the patient after discharge from your agency? (Choose only one answer.)

[ ] 1 - Patient remained in the community (not in hospital, nursing home, or rehab facility)
[ ] 2 - Patient transferred to a noninstitutional hospice [ Go to M0903 ]
[ ] 3 - Unknown because patient moved to a geographic location not served by this agency [ Go to M0903 ]
[ ] UK - Other unknown [ Go to M0903 ]

74. (M0880) After discharge, does the patient receive health, personal, or support Services or Assistance? (Mark all that apply.)

[ ] 1 - No assistance or services received
[ ] 2 - Yes, assistance or services provided by family or friends
[ ] 3 - Yes, assistance or services provided by other community resources (e.g., meals-on-wheels, home health services, homemaker assistance, transportation assistance, assisted living, board and care)

75. (M0890) If the patient was admitted to an acute care Hospital, for what Reason was he/she admitted?

[ ] 1 - Hospitalization for emergent (unscheduled) care
[ ] 2 - Hospitalization for urgent (scheduled within 24 hours of admission) care
[ ] 3 - Hospitalization for elective (scheduled more than 24 hours before admission) care
[ ] UK - Unknown

76. (M0895) Reason for Hospitalization: (Mark all that apply.)

[ ] 1 - Improper medication administration, medication side effects, toxicity, anaphylaxis
[ ] 2 - Injury caused by fall or accident at home
[ ] 3 - Respiratory problems (SOB, infection, obstruction)
[ ] 4 - Wound or tube site infection, deteriorating wound status, new lesion/ulcer
[ ] 5 - Hypo/Hyperglycemia, diabetes out of control
[ ] 6 - GI bleeding, obstruction
[ ] 7 - Exacerbation of CHF, fluid overload, heart failure
[ ] 8 - Myocardial infarction, stroke
[ ] 9 - Chemotherapy
[ ] 10 - Scheduled surgical procedure
[ ] 11 - Urinary tract infection
[ ] 12 - IV catheter-related infection
[ ] 13 - Deep vein thrombosis, pulmonary embolus
[ ] 14 - Uncontrolled pain
[ ] 15 - Psychotic episode
[ ] 16 - Other than above reasons

77. (M0900) For what Reason(s) was the patient Admitted to a Nursing Home? (Mark all that apply.)

[ ] 1 - Therapy services
[ ] 2 - Respite care
[ ] 3 - Hospice care
[ ] 4 - Permanent placement
[ ] 5 - Unsafe for care at home
[ ] 6 - Other
[ ] UK - Unknown

78. (M0903) Date of Last (Most Recent) Home Visit:

__ __ /__ __ /__ __ __ __
month / day / year

79. (M0906) Discharge/Transfer/Death Date: Enter the date of the discharge, transfer, or death (at home) of the patient.

__ __ /__ __ / __ __ __ __
month / day / year

[ ] UK - Unknown

CHANGE RECOMMENDATIONS

Recommendations for changes to the draft data set should be submitted in writing in the following format to the Information Resources Committee c/o NAHC. Attention: Data Set, 228 Seventh St. SE, Washington, DC 20003-4306.

1. Indicate the type of recommendation: change____ addition____ deletion____

2. Data Element Name:

3. Definition:

4. Explain the reason(s) for the recommendation. For changes, indicate why the current data element name/definition is not sufficient and how the change adds clarity. For additions, indicate why the data element is essential to multiple users and has relevance to national as well as local, state, or regional needs. For deletions, indicate why the data element is not essential or too difficult to collect.

Name_____________________________________ Phone______________________ Date____________

Organization_______________________________________________ NAHC ID___________________

Address_______________________________________________________________________________

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