July 9 2024
OASIS

What is a Home Health Quality Episode and Why Should I Care?

by: Lori Marmon PT, MBA, COS-C

What is a quality episode?

For quality measures based on data collected from the OASIS in the Home Health Quality Reporting Program (HHQRP), a quality episode is a component for constructing a home health quality measure. Quality episodes are used in both process measures (how well home health agency’s use specific evidence-based processes of care) and outcome measures (results of health care experienced by patients).

A quality episode begins with either a Start of Care (SOC) or a Resumption of Care (ROC) and ends with either a Transfer (TRF), Death at home (DAH) or Discharge (DC) assessment.

Quality episodes are “built” for each patient by matching the assessments from the beginning of care (SOC or ROC) to the end of care (TRF, DAH, DC). Quality episodes are not the same as certification periods or Patient-Driven Groupings Model (PDGM) payment periods.

Once the quality episodes are “built” these become the data units that are used in the calculation of the various quality measures for a reporting period.

Example: Quality Episodes in Improvement in Bathing Measure

The quality measures are created from counts of home health quality episodes that meet certain criteria. A simple way to think about the use of quality episodes is in the following example of the measure calculation for the Improvement in Bathing quality measure:

STEP 1: Counting quality episodes where the patients improved in bathing from the SOC or ROC to the end of care (EOC). Improvement is calculated at the patient-level as moving from a higher numeric OASIS score for M1830 – Bathing at SOC or ROC to a lower numeric score at discharge.

STEP 2: Computing the percentage of quality episodes exhibiting improvement for a home health agency (HHA) for the reporting period.

While this is a simplified example as it does not consider all variables that factor into quality measure calculations such as risk adjustment and measure exclusions, this example highlights how quality episodes are used in home health quality measure calculations.

Excluding Quality Episodes in Measure Calculations

Each quality episode is a “snapshot” of an agency’s performance for each patient, from SOC/ROC to TRF/DAH/DC. It’s important to note that many quality measures exclude the quality episodes that end in transfer or death when the calculation of the measure requires an end of care assessment.

The following example is a visualization of this exclusion for the Improvement in Bathing quality measure.

Patient’s Assessment Scenario

Patient’s Quality Episodes

1st Quality Episode

3/1/2024 – SOC – OASIS M1830 – Bathing = 3

(Able to participate in bathing self in shower or tub, but requires presence of another person throughout the bath for assistance or supervision).

First quality episode

Begins with SOC (3/1)

Ends with TRN (3/31)

This quality episode is excluded from the Improvement in Bathing quality measure.

3/21/2024 – OT Narrative noted improvement in bathing (no OASIS assessment completed)

The patient improved in bathing and was able to bathe with intermittent assistance only when getting into and out of the tub.

3/31/2024 – TRN – OASIS completed

The patient is transferred to an inpatient facility.

M1830 – Bathing is not collected on the transfer OASIS.

2nd Quality Episode

4/5/2024 ROC – OASIS M1830 – Bathing = 2

(Able to bath in shower or tub with intermittent assistance of another person…)

Second quality episode

Begins with ROC (4/5)

Ends with DC (4/20)

This quality episode failed the Improvement in Bathing quality measure as improvement in M1830 – Bathing has not occurred from ROC to DC.

4/20/2024 – DC – OASIS M1830 – Bathing = 2

(Able to bath in shower or tub with intermittent assistance of another person…)

In this example, even though the patient improved in their ability to bathe from SOC to DC, the quality measure is not calculated from SOC to discharge, as this situation represents 2 quality episodes:

The first quality episode was excluded from the measure results as it ended with a transfer.
As the patient did not improve in bathing from resumption of care to discharge, the second quality episode failed the Improvement in Bathing Quality Measure as there was no numeric change in the M1830 – Bathing score from ROC to discharge. Note that this situation does not always result in a failed measure, but does always exclude the gains made in the first quality episode from SOC to transfer.

Generally, the impact on the claims-based utilization measures such as the Potentially Preventable Hospitalizations (PPH) is the greatest quality measurement concern when an inpatient stay occurs. However, inpatient stays can also impact the assessment-based measures when there is a measure exclusion that ends in TRF or DAH and truncates the measurement period as was seen in the example above.

More information on quality measure calculations, including how quality episodes are used and excluded in the OASIS-based quality episodes, is available in the Home Health Quality Measure Tables on the HHQRP webpage: