Evaluating home health care nursing outcomes with OASIS and NOC.

Abstract

A multi-site study was conducted for the purpose of measuring the sensitivity and responsiveness of the Outcome and Assessment Information Set (OASIS) and the Nursing Outcomes Classification (NOC) to the effects of home health care nursing interventions. Sensitivity refers to the ability of an outcome instrument to detect change attributable to intervention. Alternatively, responsiveness is the ability of an instrument to detect change that is clinically meaningful. A convenience sample of 106 subjects referred to home health care for treatment of a cardiac condition was used. Patient outcomes data were collected at home health care admission and discharge using the OASIS and the NOC. Nursing intervention data were collected at each visit using the Nursing Interventions Classification (NIC). Intervention intensity was calculated by totaling the number of NIC interventions provided over the episode of care. The study findings demonstrated that neither the OASIS nor the NOC were sensitive to the effects of home health care nursing as measured by intervention intensity. However, reliability issues with the measurement of intervention intensity using the NIC could have impacted these findings. Neither measure was sensitive when nursing care was measured using total number of RN visits or total visit time. When effect size and standardized response mean were calculated for the OASIS and the NOC, both measures were sensitive, with the NOC demonstrating greater overall sensitivity. The OASIS was not responsive to clinically discernable change in patient outcomes. However, the NOC was responsive to patient status change in activities of daily living, cardiopulmonary status, coping, and illness management behaviors. The study results demonstrate that outcome measures that are more condition-specific and discipline-specific are more sensitive and responsive to the effects of home health care nursing. The implications of this study reveal the need for further research in order to identify and refine outcome measures that are sensitive and responsive to the effects of home health care nursing. While the identification of such measures is a challenge, the ultimate use of sensitive and responsive outcome measures will promote quality and effectiveness in home health care nursing practice.