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## Complete Summary

#### TITLE

Home health care: percentage of patients with improvement in urinary
incontinence.

#### SOURCE(S)

Crisler KS, Hittle DF, Conway KS, West LR, Shaughnessy PW, Richard AA,
Powell MC, Lawlor KL, Donelan-McCall NS, Beaudry JM, Baillie LL,
Schlenker RE, Engle K. OASIS and outcome-based quality improvement in
home health care: research and demonstration findings, policy
implications, and considerations for future change. Vol. 3, Research and
clinical supporting documents \[9 supporting documents\]. Denver (CO):
Center for Health Services Research, University of Colorado Health
Sciences Center; 2002 Feb 1.

Hittle DF, Crisler KS, Beaudry JM, Conway KS, Shaughnessy PW, West LR,
Richard AA. OASIS and outcome-based quality improvement in home health
care: research and demonstration findings, policy implications, and
considerations for future change. Vol. 4, OASIS chronicle and
recommendations. Denver (CO): Center for Health Services Research,
University of Colorado Health Sciences Center; 2002 Feb 1.

Home health compare - data details. \[internet\]. Baltimore (MD):
Centers for Medicare & Medicaid Services (CMS); \[updated 2005 Sep 01\];
\[accessed 2004 Sep 29\]. \[9 p\].

Shaughnessy PW, Crisler KS, Hittle DF, Schlenker RE, Conway KS, West LR,
Powell MC, Richard AA. OASIS and outcome-based quality improvement in
home health care: research and demonstration findings, policy
implications, and considerations for future change. Vol. 1, Policy and
program overview. Denver (CO): Center for Health Services Research,
University of Colorado Health Sciences Center; 2002 Feb 1.

Shaughnessy PW, Hittle DF, Crisler KS, Powell MC, Richard AA, Kramer AM,
Schlenker RE, Steiner JF, Donelan-McCall NS, Beaudry JM, Engle K, Conway
KS, West LR. OASIS and outcome-based quality improvement in home health
care: research and demonstration findings, policy implications, and
considerations for future change. Vol. 2, Research and technical
overview. Denver (CO): Center for Health Services Research, University
of Colorado Health Sciences Center; 2002 Feb 1.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Outcome

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of home health care
patients whose urinary incontinence improved compared to a prior
assessment

The measure identifies the presence of urinary incontinence or condition
that requires urinary catheterization of any type, including
intermittent or indwelling. The etiology (cause) of incontinence is not
addressed in this measure.

#### RATIONALE

Urinary continence is an important factor affecting patient comfort,
skin integrity, ability to engage in normal daily activities, and
ability to continue or resume independent living at home. Reduction in
or resolution of urinary incontinence in home health patients can
reflect care that is attentive to resolving a problem that restricts
patients socially as well as functionally.

This is one of 41 OASIS-based measures for which Medicare-certified home
health agencies receive performance reports from the Centers for
Medicare & Medicaid Services (CMS). The reports cover Medicare and
Medicaid adult non-maternity patients and compare each agency\'s rates
to national reference rates and to the agency\'s own rates in the
previous year. The reports provide home health agencies with information
they can use to improve quality of care by targeting care practices that
influence specific patient functioning and health status, as part of a
comprehensive quality improvement approach.

This measure is also one of ten Home Health Quality Initiative measures;
a resource to help consumers compare home health agencies, and they are
intended to motivate home health agencies to improve care and to inform
discussions about quality between consumers and clinicians.

#### PRIMARY CLINICAL COMPONENT

Home health care; urinary incontinence; urinary catheter

#### DENOMINATOR DESCRIPTION

Patients with a completed episode of care who were eligible to improve
in urinary incontinence (i.e., were not at the optimal level of health
status according to the \"Urinary Incontinence or Urinary Catheter
Presence\" OASIS\* item)

\*Outcome and Assessment Information Set (OASIS)

#### NUMERATOR DESCRIPTION

Patients from the denominator whose urinary incontinence improved
compared to a prior assessment

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A formal consensus procedure involving experts in relevant clinical,
    methodological, and organizational sciences

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance\
Variation in quality for the performance measured

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Home health compare. \[Web site\]. Baltimore (MD): Centers for Medicare
& Medicaid Services (CMS); \[updated 2007 Apr 10\]; \[accessed 2004 Sep
29\]. \[various\].

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Accreditation\
Decision-making by consumers about health plan/provider choice\
External oversight/Medicaid\
External oversight/Medicare\
Internal quality improvement\
National reporting\
Quality of care research

### Application of Measure in its Current Use

#### CARE SETTING

Home Care

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Measure is not provider specific

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

All age groups

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Frail elderly

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

In 2001, about 2.4 million elderly and disabled Americans received care
from nearly 7,000 Medicare certified home health agencies.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

2003 data compendium. \[internet\]. Baltimore (MD): Centers for Medicare
& Medicaid Services; 2003\[accessed 2004 Nov 24\]. \[5 p\].

Medicare use of selected types of long-term care. \[internet\].
Baltimore (MD): Centers for Medicare & Medicaid Services; 2003
Nov\[accessed 2004 Nov 24\]. \[1 p\].

Other Medicare providers and suppliers. \[internet\]. Baltimore (MD):
Centers for Medicare & Medicaid Services; 2003 Nov\[accessed 2004 Nov
24\]. \[1 p\].

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Many home health care patients are frail elders with chronic health
conditions, functional disabilities, or cognitive impairments. Such
patient characteristics are included in the statistical models used to
risk adjust home health agency outcome rates for differences in the
types of patients served. In addition, the capability exists to derive
outcome rates separately for vulnerable populations for comparison with
outcome rates for other population groups.

#### EVIDENCE FOR ASSOCIATION WITH VULNERABLE POPULATIONS

Center for Health Services Research, UCHSC. Documentation of prediction
models used for risk adjustment of home health agency outcomes reported
on the CMS Home Health Compare Web site. Denver (CO): Center for Health
Services Research, UCHSC; 2003. 29 p.

Shaughnessy PW, Crisler KS, Hittle DF, Schlenker RE, Conway KS, West LR,
Powell MC, Richard AA. OASIS and outcome-based quality improvement in
home health care: research and demonstration findings, policy
implications, and considerations for future change. Vol. 1, Policy and
program overview. Denver (CO): Center for Health Services Research,
University of Colorado Health Sciences Center; 2002 Feb 1.

Shaughnessy PW, Hittle DF. Overview of risk adjustment and outcome
measures for home health agency OBQI reports: highlights of current
approaches and outline of planned enhancements. Denver (CO): Center for
Health Services Research, University of Colorado Health Sciences Center;
2002 Sep. 22 p. \[28 references\]

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All adult, non-maternity skilled care patients admitted to
Medicare-certified home health agencies

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients with a completed episode of care who were eligible to improve
in urinary incontinence (i.e., were not at the optimal level of health
status according to the \"Urinary Incontinence or Urinary Catheter
Presence\" OASIS\* item)

\*Outcome and Assessment Information Set (OASIS)

**Exclusions**\
Data collected about patients serviced by a Medicaid-only certified
agency, those whose care is paid for entirely by sources other than
Medicare or Medicaid, those under the age of 18, those receiving
maternity services only, and those receiving only personal
care/supportive services are not submitted to the federal government,
therefore these types of patients are excluded from this measure.
Patients whose status at start of care indicates a nonresponsive level
of consciousness or whose episode of home health care ends with death or
with a transfer to an inpatient facility (i.e., hospital, rehabilitation
facility, nursing home, or hospice) for 24 hours or more are excluded.
Patients who have not yet been discharged or transferred to an inpatient
facility (incomplete episode of care) are excluded.

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients from the denominator whose urinary incontinence improved
compared to a prior assessment

**Exclusions**\
Patients from the denominator whose urinary incontinence did not improve
compared to a prior assessment

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Episode of care

#### DATA SOURCE

Special or unique data

#### LEVEL OF DETERMINATION OF QUALITY

Not Individual Case

#### OUTCOME TYPE

Clinical Outcome

#### PRE-EXISTING INSTRUMENT USED

The Outcome and Assessment Information Set (OASIS) for Home Care

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Case-mix adjustment\
Risk adjustment method widely or commercially available

#### DESCRIPTION OF ALLOWANCE FOR PATIENT FACTORS

To reduce the chance that a home health agency that serves sicker,
older, or more frail patients looks worse in the quality measures, the
quality measures are risk adjusted. Percentages are adjusted using
predicted rates for each agency based on patient characteristics at
admission to home health care. For a detailed explanation of risk
adjustment please visit [Overview of Risk Adjustment and Outcome
Measures for Home Health Agency OBQI Reports: Highlights of Current
Approaches and Outline of Planned
Enhancements](http://www.cms.hhs.gov/oasis/RiskAdj1.pdf).

#### STANDARD OF COMPARISON

External comparison at a point in time\
Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Measure is based on the best research currently available, including
testing in a national quality improvement demonstration. For more
information, refer to OASIS and Outcome-based Quality Improvement in
Home Health Care: Research and Demonstration Findings, Policy
Implications, and Considerations for Future Change. Volume 4, OASIS
Chronicle and Recommendations.

#### EVIDENCE FOR RELIABILITY/VALIDITY TESTING

Hittle DF, Crisler KS, Beaudry JM, Conway KS, Shaughnessy PW, West LR,
Richard AA. OASIS and outcome-based quality improvement in home health
care: research and demonstration findings, policy implications, and
considerations for future change. Vol. 4, OASIS chronicle and
recommendations. Denver (CO): Center for Health Services Research,
University of Colorado Health Sciences Center; 2002 Feb 1.

Hittle DF, Shaughnessy PW, Crisler KS, Powell MC, Richard AA, Conway KS,
Stearns PM, Engle K. A study of reliability and burden of home health
assessment using OASIS. Home Health Care Serv Q2003;22(4):43-63.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14998281)

Madigan EA, Fortinsky RH. Interrater reliability of the outcomes and
assessment information set: results from the field. Gerontologist2004
Oct;44(5):689-92.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15498844)

### Identifying Information

#### ORIGINAL TITLE

Improvement in urinary incontinence.

#### MEASURE COLLECTION

[Outcome and Assessment Information Set
(OASIS)](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=11&doc=3889)

#### MEASURE SET NAME

[Outcome-Based Quality Improvement (OBQI)
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=11&doc=3938)

#### SUBMITTER

Centers for Medicare & Medicaid Services

#### DEVELOPER

Center for Health Services Research, University of Colorado, under
contract to Centers for Medicare and Medicaid Services

#### ENDORSER

National Quality Forum

#### INCLUDED IN

Home Health Compare\
National Healthcare Disparities Report (NHDR)\
National Healthcare Quality Report (NHQR)

#### ADAPTATION

This measure was not adapted from another source.

#### RELEASE DATE

1998 Oct

#### REVISION DATE

2002 Feb

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

Crisler KS, Hittle DF, Conway KS, West LR, Shaughnessy PW, Richard AA,
Powell MC, Lawlor KL, Donelan-McCall NS, Beaudry JM, Baillie LL,
Schlenker RE, Engle K. OASIS and outcome-based quality improvement in
home health care: research and demonstration findings, policy
implications, and considerations for future change. Vol. 3, Research and
clinical supporting documents \[9 supporting documents\]. Denver (CO):
Center for Health Services Research, University of Colorado Health
Sciences Center; 2002 Feb 1.

Hittle DF, Crisler KS, Beaudry JM, Conway KS, Shaughnessy PW, West LR,
Richard AA. OASIS and outcome-based quality improvement in home health
care: research and demonstration findings, policy implications, and
considerations for future change. Vol. 4, OASIS chronicle and
recommendations. Denver (CO): Center for Health Services Research,
University of Colorado Health Sciences Center; 2002 Feb 1.

Home health compare - data details. \[internet\]. Baltimore (MD):
Centers for Medicare & Medicaid Services (CMS); \[updated 2005 Sep 01\];
\[accessed 2004 Sep 29\]. \[9 p\].

Shaughnessy PW, Crisler KS, Hittle DF, Schlenker RE, Conway KS, West LR,
Powell MC, Richard AA. OASIS and outcome-based quality improvement in
home health care: research and demonstration findings, policy
implications, and considerations for future change. Vol. 1, Policy and
program overview. Denver (CO): Center for Health Services Research,
University of Colorado Health Sciences Center; 2002 Feb 1.

Shaughnessy PW, Hittle DF, Crisler KS, Powell MC, Richard AA, Kramer AM,
Schlenker RE, Steiner JF, Donelan-McCall NS, Beaudry JM, Engle K, Conway
KS, West LR. OASIS and outcome-based quality improvement in home health
care: research and demonstration findings, policy implications, and
considerations for future change. Vol. 2, Research and technical
overview. Denver (CO): Center for Health Services Research, University
of Colorado Health Sciences Center; 2002 Feb 1.

#### MEASURE AVAILABILITY

The individual measure, \"Improvement in Urinary Incontinence,\" is
published in \"OASIS and Outcome-Based Quality Improvement in Home
Health Care: Research and Demonstration Findings, Policy Implications,
and Considerations for Future Change. Volumes 1-4.\"

#### COMPANION DOCUMENTS

The following are available:

-   Shaughnessy PW, Hittle DF. Overview of risk adjustment and outcome
    measures for home health agency OBQI reports: highlights of current
    approaches and outline of planned enhancements. Denver (CO): Center
    for Health Services Research, University of Colorado Health Sciences
    Center; 2002 Sep. 22 p. This document is available in Portable
    Document Format (PDF) from the [Centers for Medicare & Medicaid
    Services (CMS) Web
    site](http://www.cms.hhs.gov/HomeHealthQualityInits/downloads/HHQIOASISOBQIOverviewRA.pdf).

-   Home health compare. \[Web site\]. Baltimore (MD): Centers for
    Medicare & Medicaid Services (CMS); \[updated 2007 Apr 10\]; \[cited
    2004 Sep 29\]. \[various\]. Available at
    [www.medicare.gov/HHCompare](http://www.medicare.gov/HHCompare/Home.asp?version=default&browser=IE|6|WinXP&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True).
    See the related
    [QualityTools](http://www.innovations.ahrq.gov/content.aspx?id=1100)
    summary.

-   Outcome and Assessment Information Set (OASIS) implementation
    manual: implementing OASIS at a Home Health Agency to improve
    patient outcomes. Baltimore (MD): Centers for Medicare & Medicaid
    Services; 2008 Jan \[revised\]. This document is available from the
    [CMS Web
    site](http://www.cms.hhs.gov/HomeHealthQualityInits/14_HHQIOASISUserManual.asp).

-   Outcome-Based Quality Improvement (OBQI) implementation manual.
    Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2002
    Feb. Various pagings. This document is available from the [CMS Web
    site](http://www.cms.hhs.gov/HomeHealthQualityInits/16_HHQIOASISOBQI.asp#TopOfPage).

#### NQMC STATUS

This NQMC summary was completed by ECRI on March 21, 2005. The
information was verified by the measure developer on June 20, 2005 and
was reviewed and edited on September 26, 2005.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

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Date Modified: 11/10/2008