Evaluation Method of Home Care Agency from Care Effectiveness for Clients : Comparative Study of Standard Value and Agency Based on Adjustment of Clients' Background

Abstract

Objective : The purpose of this study was to explore an evaluation method of effectiveness of home care in practice. We studied an adjustment method of clients' background related to outcomes in order to enable us to compare standard outcomes (improvement and stabilization of clients) in five home care agencies. Based on the adjustment method, we identified outcomes of each agency. Method : Subjects were those who were aged 40-64 years eligible for the long-term care insurance and those who were aged 65 years and older. Of 609 clients in five home care agencies from September to December 1999, we excluded terminal clients who were difficult to measure outcomes. We analyzed 451 clients who received consecutive two-month care and whose outcomes were measured. We studied the summary version of OASIS (The Outcomes Assessment Information Set) mandated for Medicare patients in the United States developed by Peter W. Shaughnesssy, et al. and used all the items in our study because the outcome study by Japan Visiting Nursing Foundation found its applicability. For clients' background information, we analyzed 6 items necessary for Japan from the previous literature. Results : Clients' backgrounds related to outcomes in five home care agencies were independent (four levels, J A B C in the Independence of Disabled Elderly in Daily Life) and dementia levels (six levels, non-dementia to M in the Independence of Demented Elderly in Daily Life). The results clearly revealed that these two levels needed to be adjusted for clients' outcomes (improvement and stabilization) in each agency. We tested differences between percentages of each agency and all the agencies, and significant differences were outcomes we should pay attention. In Agency A where many items were significantly higher than the standards, improvement was seen in grooming, washing, ambulation, preparation of snacks, pain and incontinence when the independent level was adjusted, while grooming, washing, transferring, preparation of meal and medicine administration were improved when the dementia level was adjusted. As a result, outcomes in each agency can be objectified and accuracy of evaluation can be improved by adjusting standard outcomes and clients' background related to outcomes. This study can be useful for identifying care services which should be improved in quality, clients' outcome management by care manager, and the third-party evaluation. Also, users will be able to choose home care agency if evaluation results are open to the public.