Research article

Functional status decline as a measure of adverse events in home health care: an observational study

Tanya Pollack Scharpf¹ , Natalie Colabianchi¹ , Elizabeth A Madigan² , Duncan Neuhauser¹ , Timothy Peng³ , Penny H Feldman³ and John FP Bridges⁴

¹  Case Western Reserve University, Department of Epidemiology and Biostatistics, 10900 Euclid Avenue, Cleveland, OH 44106, USA

²  Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Avenue, Cleveland, OH 44106, USA

³  The Center for Home Care Policy and Research, Visiting Nurse Service of New York, 107 East 70^th Street, New York, New York 10021, USA

⁴  Department of Tropical Hygiene and Public Health, University of Heidelberg – Medical School, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany

author email corresponding author email

BMC Health Services Research 2006, 6:162doi:10.1186/1472-6963-6-162

Published:	20 December 2006

Abstract

Background

Research that examines the quality of home health care is complex because no gold standard exists for measuring adverse outcomes, and because the patient and clinician populations are highly heterogeneous. The objectives in this study are to develop models to predict functional decline for three indices of functional status as measures of adverse events in home health care and determine which index is most appropriate for risk-adjusting for future quality research.

Methods

Data come from the Outcomes and Assessment Information Set (OASIS) from a large urban home health care agency and other agency data. Prognostic data yields 49,437 episodes, while follow-up data yields 47,684 episodes. We tested three indices defined as substantial decline in three or more (gt3_ADLs), two or more (gt2_ADLs), and one or more (gt1_ADLs) ADLs. Multivariate logistic regression determines the performance of the models for each index as measured by the c-statistic and Hosmer-Lemeshow chi square (χ²).

Results

Frequencies for gt3_ADLs, gt2_ADLs, and gt1_ADLs are 212 (0.43%), 783 (1.58%), and 4,271 (8.64%) respectively. Follow-up results are comparable with frequencies of 218 (0.46%), 763 (1.60%), and 3,949 (8.28%) for each index. Gt3_ADLs does not produce valid models. The model for gt2_ADLs consistently yields a higher c-statistic compared to gt1_ADLs (0.754 vs. 0.679, respectively). Both indices' models yield non-significant Hosmer-Lemeshow chi square indicating reasonable model fit. Findings for gt2_ADLs and gt1_ADLs are consistent over time as indicated by follow-up data results.

Conclusion

Gt2_ADLs yields the best models as indicated by a high c-statistic and a non-significant Hosmer-Lemeshow χ², both of which exhibit exceptional consistency. We conclude that gt2_ADLs may be preferable in defining ADL adverse events in the context of home health care.