How Good Is Your Home Care
How Good Is Your Home Care?
Simple Questionnaire Can Help Measure Your Effectiveness
Limited available evidence of the effectiveness of many existing and emerging medical practices has led many caregivers to the realization that health outcome data should be used in the evaluation of health care interventions in the home care arena as it is elsewhere.
Such interest in improving health outcome evaluations is increasing as a result of the need to balance costs and benefits of home care therapy against the end results. Among indicator data, quality of life measurement provides additional data for making clinical and health care policy decisions.
Four domains contribute to this overall effect: physical and occupational function, psychological state, social interaction and economic status.
As a leading home health care provider, staff at the Home Health Corp. of America felt it was necessary to implement a system that goes beyond simple measurements of satisfaction in providing optimal patient care.
To attain that goal, we use an evaluation tool that in combination with our current compliance monitoring system helps demonstrate whether delivered therapy is actually improving the patient’s quality of life.
For that purpose, we use the SF-12 form from Quality Metrics Inc., Lincoln, R.I.
Within our organization, the SF-12 questionnaire is administered by a respiratory therapist starting a patient on CPAP, BiPAP or oxygen.
Once the therapist returns the form to the office, SF-12 questionnaires are scored via a computer program, reviewed and then stored. After six months, another SF-12 questionnaire is administered and scored. The results of the two assessments are then graphed and sent to the ordering physician for interpretation.
The First Six Months
A total of 41 CPAP patients and 16 continuous oxygen patients were evaluated using SF-12. The table below lists the Physical Component Score (PCS) and the Mental Component Score (MCS) at the start of therapy and after six months of therapy.
- Pre-Treatment CPAP Means Scores PCS 43.48 MCS 48.88
- Six Month on Therapy Means Scores PCS 43.6 MCS 54.887
- Pre-Treatment Oxygen Means Scores PCS 28.82 MCS 45.91
- Six Months on Therapy Means Scores PCS 29.83 MCS 54.24
The PCS and MCS are scored using norm-based methods. Physician and mental regression weights and constants come from the general U.S. population. Both the PCS and MCS scales are transformed to have a mean of 50 and a standard deviation of 10 in the general U.S. population.
Specifically, all scores above and below 50 are above and below the average in the general U.S. population. Each one-point change represents a one-tenth standard deviation change in an individual or a group population. So a PCS or MCS score change from 40 to 42 would represent two-tenths of a standard deviation unit of improvement.
In our study of the CPAP group, there was essentially no change in the PCS scores. But since all of the patients in the group are Obstructive Sleep Apnea (OSA) patients between the ages of 20 and 52 years, we did not expect to see much change in this area.
However, the MCS showed a substantial 6-point increase. Since most OSA patients also suffer from increased mental stress, depression and anxiety, this is the type of improvement that shows the benefits of CPAP for treating this population.
In the oxygen group, there was a small increase in the PCS score and again a substantial increase in the MCS score. Since this group was relatively small, it is hard to draw any definitive conclusion from it.
We hope to have a larger group to draw from by next year. Since there is no national data base for CPAP, BiPAP and oxygen use as they relate to measurable improvements in quality of life, we hope to establish norms as our group gets larger.
The take-home lesson from all this is that by working with the patient and the patient’s physician, therapists can find ways to improve the care they provide.
James R. Criasia, Canton, Mass., is the director of Respiratory Care Services, Home Health Corp. of America.