Alternative Risk-Adjustment Approaches to Assessing the Quality of Home Health Care: Final Report


LIST OF FIGURES
FIGURE 1: Performance of Alternative and Current Risk-Adjustment Models for Improvement in ADL Outcomes
FIGURE 2: Performance of Alternative and Current Risk-Adjustment Models for Improvement in IADL Outcomes
FIGURE 3: Performance of Alternative and Current Risk-Adjustment Models for Improvement in Physiologic and Cognitive Outcomes
FIGURE 4: Performance of Alternative and Current Risk-Adjustment Models for Utilization Outcomes
FIGURE 5: Inclusion of OASIS-B1 Items in Risk-Adjustment Models
FIGURE 6: Inclusion of OASIS-B1 Elements in Risk-Adjustment Models
FIGURE 7: Mean Percentage Point Difference in Agency Performance Using Current versus Full Alternative Models
FIGURE 8: Spearman’s Rank Correlation Coefficient for Agency Outcomes Using Current versus Full Alternative Models
FIGURE 9: Mean Percentage Point Difference in Agency Performance Using Current versus Core Alternative Models
FIGURE 10: Spearman’s Rank Correlation Coefficient for Agency Outcomes Using Current versus Core Alternative Models
LIST OF TABLES
TABLE 1: Outcome Measures Used in OBQI
TABLE 2: Preliminary Set of Core Risk Factors Used in Initial Analyses
TABLE 3: Final Set of Core Items Included as Risk-Adjusters in All Alternative Models
TABLE 4a: Risk-Adjusters Specific to ADL Outcome Models
TABLE 4b: Risk-Adjusters Specific to IADL Outcome Models
TABLE 4c: Risk-Adjusters Specific to Physiologic Outcome Models
TABLE 4d: Risk-Adjusters Specific to Cognitive and Utilization Outcomes
TABLE 5a: “Prior” Risk-Adjusters Specific to ADL Outcomes
TABLE 5b: “Prior” Risk-Adjusters Specific to IADL Outcomes
TABLE 5c: “Prior” Risk-Adjusters Specific to Physiologic Outcomes
TABLE 5d: “Prior” Risk-Adjusters Specific to Emotional/Behavioral/Cognitive Outcomes
TABLE 6a: Summary of Regression Models: Activities of Daily Living
TABLE 6b: Final Alternative Risk-Adjustment Models for Activities of Daily Living Outcomes
TABLE 7a: Summary of Regression Models: Instruments Activities of Daily Living
TABLE 7b: Final Alternative Risk-Adjustment Models for Instrumental Activities of Daily Living Outcomes
TABLE 8a: Summary of Regression Models: Physiologic Measures
TABLE 8b: Final Alternative Risk-Adjustment Models for Physiologic Outcomes
TABLE 9a: Summary of Regression Models: Emotional/Behavioral Measures
TABLE 9b: Final Alternative Risk-Adjustment Models for Emotional/Behavioral Outcomes
TABLE 10a: Summary of Regression Models: Cognitive Measures
TABLE 10b: Final Alternative Risk-Adjustment Models for Cognitive Outcomes
TABLE 11a: Summary of Regression Models: Utilization Measures
TABLE 11b: Final Alternative Risk-Adjustment Models for Utilization Outcomes
TABLE 12: Summary of Agency-Level Analyses: Activities of Daily Living
TABLE 13: Summary of Agency-Level Analyses: Instrumental Activities of Daily Living
TABLE 14: Summary of Agency-Level Analyses: Physiologic Measures
TABLE 15: Summary of Agency-Level Analyses: Cognitive Measures
TABLE 16: Summary of Agency-Level Analyses: Utilization Measures


FIGURES

FIGURE 1. Performance of Alternative and Current Risk-Adjustment Models for Improvement in ADL Outcomes
Performance of Alternative and Current Risk-Adjustment Models for Stabilization in ADL Outcomes
NOTE: Vertical height (the y-axis) indicates the explanatory power of the alternative risk-adjustment models with: (1) only the core risk factors (the dark shade at the bottom of the column), (2) the addition of the outcome specific risk-adjusters (the speckled section), and (3) the addition of relevant “prior” OASIS items (the light shade at the top of the column). The short, solid line above or within the column indicates the explanatory power of the current (“U of CO”) risk-adjustment model. See methods section for the definition of the pseudo-R-squared measure of explanatory power.


FIGURE 2. Performance of Alternative and Current Risk-Adjustment Models for Improvement in IADL Outcomes
Performance of Alternative and Current Risk-Adjustment Models for Stabilization in IADL Outcomes
NOTE: Vertical height (the y-axis) indicates the explanatory power of the alternative risk-adjustment models with: (1) only the core risk factors (the dark shade at the bottom of the column), (2) the addition of the outcome specific risk-adjusters (the speckled section), and (3) the addition of relevant “prior” OASIS items (the light shade at the top of the column). The short, solid line above or within the column indicates the explanatory power of the current (“U of CO”) risk-adjustment model. See methods section for the definition of the pseudo-R-squared measure of explanatory power.


FIGURE 3. Performance of Alternative and Current Risk-Adjustment Models for Improvement in Physiologic and Cognitive Outcomes
NOTE: Vertical height (the y-axis) indicates the explanatory power of the alternative risk-adjustment models with: (1) only the core risk factors (the dark shade at the bottom of the column), (2) the addition of the outcome specific risk-adjusters (the speckled section), and (3) the addition of relevant “prior” OASIS items (the light shade at the top of the column). The short, solid line above or within the column indicates the explanatory power of the current (“U of CO”) risk-adjustment model. See methods section for the definition of the pseudo-R-squared measure of explanatory power.


FIGURE 4. Performance of Alternative and Current Risk-Adjustment Models for Utilization Outcomes
NOTE: Vertical height (the y-axis) indicates the explanatory power of the alternative risk-adjustment models with: (1) only the core risk factors (the dark shade at the bottom of the column), (2) the addition of the outcome specific risk-adjusters (the speckled section), and (3) the addition of relevant “prior” OASIS items (the light shade at the top of the column). The short, solid line above or within the column indicates the explanatory power of the current (“U of CO”) risk-adjustment model. See methods section for the definition of the pseudo-R-squared measure of explanatory power.


FIGURE 5. Inclusion of OASIS-B1 Items in Risk-Adjustment Models
M0200 M0220 M0100 M0190 M0210 M0280        
M0066 M0250* M0290 M0300 M0340 M0350 M0360 M0140 M0180  
M0069 M0150 M0430 M0500 M0370 M0380 M0400 M0450* M0474 M0486
M0175* M0230* M0510 M0640P M0650P M0464 M0470 M0484 M0810 M0820
M0230S* M0240* M0240S* M0260 M0660P M0670P M0488* M0550* M0620 M0825*
M0270 M0390* M0410 M0420* M0440* M0680P M0690P M0630 M0730P M0790
M0445 M0460* M0468 M0476* M0482 M0700P M0710P M0720P M0790P M0800
M0490* M0520 M0530* M0540* M0560 M0570 M0580 M0740P M0750P M0800P
M0590 M0610* M0640 M0650* M0660* M0670* M0680* M0690* M0760P M0770P
M0700* M0710 M0720 M0730 M0740 M0750 M0760 M0770 M0780 M0780P
  LEGEND  
Items used in: Core
(43)		 Full
(64)		 U of Co
Models
(88)		 Not
Used
(7)
OASIS ITEM       X
OASIS ITEM     X  
OASIS ITEM   X X  
OASIS ITEM X X X  
NOTE: There is a total of 95 OASIS items for risk-adjustment.

* Item used in home health resource group case-mix classification for Medicare payment.


FIGURE 6. Inclusion of OASIS-B1 Elements in Risk-Adjustment Models
M0175_NA* M0100 M0150_1 M0190_A M0140_1 M0140_2 M0140_3 M0140_4 M0140_5 M0140_6 M0140_UK    
M0200 M0220_1 M0190_B M0210_A M0210_B M0150_0 M0150_5 M0150_6 M0150_7 M0150_8 M0150_9 M0150_10 M0150_11
M0220_2 M0220_3 M0220_4 M0210_C M0210_D M0220_UK M0150_UK M0175_5* M0180 M0220_7 M0220_NA M0250_3* M0250_4*
M0066 M0220_5 M0220_6 M0250_1* M0250_2* M0280 M0290_4 M0290_3 M0340_4 M0340_5 M0340_6 M0825 M0350_3
M0069 M0150_2 M0290_1 M0290_2 M0290_3 M0300 M0340_1 M0340_2 M0380_3 M0380_4 M0380_5 M0380_6 M0380_7
M0150_3 M0150_4 M0175_1* M0290_UK M0430 M0340_3 M0350_1 M0350_2 M0350_4 M0380_UK M0450_E* M0474 M0486
M0175_2* M0175_3* M0175_4* M0230_A* M0300_2 M0510 M0350_UK M0360 M0370 M0380_1 M0500_3 M0500_4 M0550*
M0230S_A* M0240_B* M0240_C* M0240_D* M0610_1* M0610_2* M0610_5* M0380_2 M0400 M0450_A* M0450_B* M0610_7* M0810
M0240_E* M0240_F* M0240S_B* M0240S_C_D* M0240S_D* M0640P M0650P M0660P M0450_C* M0450_D* M0464 M0470 M0820
M0240S_E* M0240S_F* M0260 M0270 M0390* M0410 M0670P M0680P M0690P M0484 M0488* M0500_1 M0610_4*
M0420* M0440* M0445 M0460* M0468 M0476* M0482 M0700P M0710P M0720P M0610_6* M0620 M0630
M0490* M0520 M0530* M0540* M0560 M0570 M0580 M0590_1 M0590_2 M0740P M0750P M0730P M0790
M0590_3 M0590_4 M0590_5 M0590_6 M0610_3* M0640 M0650* M0660* M0670* M0680* M0760P M0790P M0800
M0690* M0700* M0710 M0720 M0730 M0740 M0750 M0760 M0770 M0780 M0770P M0780P M0800P
  LEGEND  
Elements Used In: Core
(61)		 Full
(93)		 U of Co
(135)		 Not Used
(43)
OASIS Element       X
OASIS Element     X  
OASIS Element   X X  
OASIS Element X X X  
OASIS Element X X    
NOTE: There is a total of 180 OASIS elements for risk-adjustment.

* Item used in home health resource group case-mix classification for Medicare payment.


FIGURE 7. Mean Percentage Point Difference in Agency Performance Using Current versus Full Alternative Models
NOTE: Each point represents the average agency percentage point difference between patient outcomes predicted by the current model and the patient outcomes predicted by the full alternative model. Above and below each point is a set of bars representing a two standard deviation span for each outcome, centered on the mean.


FIGURE 8. Spearman’s Rank Correlation Coefficient for Agency Outcomes Using Current versus Full Alternative Models
NOTE: Each point represents the value of Spearman’s rank correlation coefficient for the ordinal ranking of agencies on their patient outcomes using the current model compared to rankings using the full alternative risk-adjustment model. It is a standard correlation coefficient, ranging from -1 to 1. In this figure, a value of 0 represents no relationship between the rankings, -1 represents perfectly opposite rankings, and 1 represents perfectly matching ranks produced by the models being compared. For purposes of presentation, only the range from 0.85 to 1 on the vertical (y) axis is shown in this figure.


FIGURE 9. Mean Percentage Point Difference in Agency Performance Using Current versus Core Alternative Models
NOTE: Each point represents the average agency percentage point difference between patient outcomes predicted by the current model and the patient outcomes predicted by the core alternative model. Above and below each point is a set of bars representing a two standard deviation span for each outcome, centered on the mean.


FIGURE 10. Spearman’s Rank Correlation Coefficient for Agency Outcomes Using Current versus Core logic and Cognitive Outcomes
NOTE: Each point represents the value of Spearman’s rank correlation coefficient for the ordinal ranking of agencies on their patient outcomes using the current model compared to rankings using the core alternative risk-adjustment model. It is a standard correlation coefficient, ranging from -1 to 1. In this figure, a value of 0 represents no relationship between the rankings, -1 represents perfectly opposite rankings, and 1 represents perfectly matching ranks produced by the models being compared. For purposes of presentation, only the range from 0-85 to 1 on the vertical (y) axis is shown in this figure.


TABLES

TABLE 1. Outcome Measures Used in OBQI
HEALTH STATUS OUTCOME MEASURES
Functional: Activities of Daily Living
   Improved in:
      Ambulation/locomotion
      Dressing upper body
      Dressing lower body
      Grooming
      Bathing
      Eating
      Toileting
      Transferring

   Stabilized in:
      Grooming
      Bathing
      Transferring		 Functional: Instrumental Activities of Daily Living
   Improved in:
      Management of oral medications
      Light meal preparation
      Laundry
      Housekeeping
      Shopping
      Telephone use

   Stabilized in:
      Management of oral medications
      Light meal preparation
      Laundry
      Housekeeping
      Shopping
      Telephone use
Physiologic
   Improved in:
      Pain interfering with activity
      Number of surgical wounds
      Status of surgical wounds
      Dyspnea
      Urinary tract infection
      Urinary incontinence
      Bowel incontinence
      Speech or language

   Stabilized in:
      Speech or language   		Emotional Behavioral
   Improved in:
      Anxiety level
      Behavioral problem frequency

   Stabilized in:
      Anxiety level  
Cognitive
   Improved in:
      Confusion frequency
      Cognitive functioning

   Stabilized in:
      Cognitive functioning  
UTILIZATION OUTCOME MEASURES
      Acute care hospitalization
      Discharge to community
      Emergent care  
NOTES: Adapted from Shaughnessy, P.W. and Hittle, D.F. 2002. “Overview of Risk Adjustment and Otucome Measures for Home Health Agency OBQI Reports” (available at http://www.cms.gov/providers/hha/RiskAdj1.pdf).

Outcomes labeled as “Improved in” are binary indicators of whether status at discharge is better than at start of the episode on that outcome. Episodes that start at the ceiling of the outcome measure (i.e., those that could not improve because they are already at the top) are excluded from the denominator for “Improvement” outcomes.

Outcomes labeled as “Stabilized in” are binary indicators of whether status at discharge is the same or better at discharge as compared to the start of the episode for that outcome. Episodes that start at the floor of the outcome measure (i.e., those that could not get worse because they start at the worst level), are excluded from the denominator for “Stabilization” outcomes.


TABLE 2. Preliminary Set of Core Risk Factors Used in Initial Analyses
Preliminary Core Risk Factors OASIS Items Specification
DEMOGRAPHICS
   Age M0066 <65
65-74 (reference category)
75-84
85+
   Sex M0069 Female
Male (reference category)
SOCIOECONOMIC FACTORS
Insurance/Payment:
   Any Medicare M0150 Yes
No (reference category)
Informal Support/Assistance:
   ADL assistance provided by caregiver M0350, M0360, M0380 Yes
No (reference category)
   Frequency of assistance M0350, M0360, M0370 Scale 0-6 (0 = no caregiver)
Living Situation:
   Lives alone M0340 Yes
No (reference category)
   Lives with spouse/family M0340 Yes
No (reference category)
PRIOR SERVICE USE
Discharge Past 14 Days:
   Discharge from hospital M0175 Yes
No (reference category)
   Discharge from nursing home
   Discharge from rehabilitation facility
CLINICAL FACTORS
Prognoses:
   Overall prognosis M0260 Poor (reference category)
Good/fair
   Rehab prognosis M0270 Guarded (reference category)
Good
   Life expectancy M0280 Greater than 6 mo. (reference category)
Less than 6 months
Diagnoses:
   Infectious/parasitic diseases M0190, M0210, M0230, M0240 For each major diagnosis category:  
Yes
No (reference category)
(Note: diagnoses are not mutually exclusive)
   Neoplasms
   Endocrine/metabolic
   Blood diseases
   Mental diseases
   Nervous system
   Circulatory system
   Respiratory system
   Digestive system
   Genitourinary
   Skin/subcutaneous
   Musculoskeletal system
   Ill-defined conditions
   Fractures
   Other injury
   Iatrogenic conditions
Diagnosis Severity:
   Number of severity ratings >2 M0230_S, M0240S Integer count (range 0 to 6)
Sensory Status:
   Hearing impairment M0400 No impairment (reference category)
Minimal difficulty
Moderate difficulty
Severe difficulty (categories 3-4)
   Vision impairment M0390 Normal (reference category)
Partially impaired
Severely impaired
   Speech/language impairment M0410 No impairment (reference category)
Minimal difficulty
Moderate difficulty
Severe difficulty (categories 3-5)
Integumentary Status:
   Surgical wound present M0480 Yes
No (reference category)
   Stage of most problematic pressure ulcer M0440, M0445, M0460 Scale 0-4 (0 = No pressure ulcer)
   Status of most problematic stasis ulcer M0440, M0468, M0476 Scale 0-3 (0 = No stasis ulcer)
Physical Functioning:
   ADL/IADL summary score M0640 through M0780 Integer count 0-14 (0 = No dependencies)
Elimination Status:
   Urinary incontinence severity M0520, M0530 No incontinence (reference category)
Timed voiding deters incontinence
Night only
Day and Night
   Urinary catheter M0520 Yes
No (reference category)
   Bowel incontinence M0540 Rarely or Never (reference category)
Less than once weekly
1-3 times weekly
4-6 times weekly
Daily or more often (categories 4-5)
   Ostomy for bowel elimination M0550 Yes (categories 1-2)
No (reference category)
Neuro/Emotional/Behavioral Status:
   Cognitive functioning M0560 No impairments (reference category)
Requires prompting
Requires assistance and some direction
Requires considerable assistance
Totally dependent
   Confusion frequency M0570 Never (reference category)
New or complex situations only
On awakening or at night
Day and evening, not constantly
Constantly
   Anxiety frequency M0580 None (reference category)
Less often than daily
Daily, but not constantly
All of the time
   Verbal disruption M0610_3 Yes
No (reference category)
   Number of symptoms of depression M0590 None (reference category)
One symptom only
More than one symptom


TABLE 3. Final Set of Core Items Included as Risk-Adjusters in All Alternative Models
Core Variables OASIS Items Specification
DEMOGRAPHICS
   Age M0066 <65
65-74 (reference category)
75-84
85+
   Sex M0069 Female
Male (reference category)
SOCIOECONOMIC FACTORS
   Current payer M0150 Any Medicaid
Medicare HMO
Medicare FFS and Other (reference category)
PRIOR SERVICE USE
Discharge Past 14 Days:
   Discharge from hospital M0175 Yes
No (reference category)
   Discharge from rehabilitation facility
   Discharge from nursing home
CLINICAL FACTORS
Baseline value of outcome indicator Varies depending on outcome indicator   
Prognoses:
   Overall prognosis M0260 Poor (reference category)
Good/fair
   Rehabilitation prognosis M0270 Guarded (reference category)
Good
Diagnoses:
   Diabetes (PPS group) M0230, M0240 Yes
No (reference category)
(Note: diagnoses are not mutually exclusive)
   Neurological (PPS group)
   Orthopedic (PPS group)
   Wound/Burn (PPS group)
   Dementia
   Hypertension
   Ischemia
   Arrhythmia
   Heart failure
   COPD
   Skin ulcer
   Orthopedic (other than PPS)
   Incontinence
   Cancer
   Mental condition
   Signs, symptoms, and Ill-defined conditions
Diagnosis Severity:
   Number of severity ratings >2 M0230S, M0240S Integer count (range 0 to 6)
Sensory Status:
   Vision M0390 Normal (reference category)
Partially impaired
Severely impaired
   Speech/language M0410 No impairment (reference category)
Minimal difficulty
Moderate difficulty
Severe difficulty (categories 3-5)
Integumentary Status:
   Surgical wound present M0482 Yes
No (reference category)
   Stage of most problematic pressure ulcer M0440, M0445, M0460 Scale 0-4 (0 = No pressure ulcer)
   Status of most problematic stasis ulcer M0440, M0468, M0476 Scale 0-3 (0 = No stasis ulcer)
Physical Functioning:
   ADL/IADL summary score M0640 through M0780 Integer count 0-14 (0 = No impairment)
Elimination Status:
   Urinary incontinence severity M0520, M0530 No incontinence (reference category)
Timed voiding deters incontinence
Night only
Day and Night
   Urinary catheter M0520 Yes
No (reference category)
   Bowel incontinence M0540 Rarely or Never (reference category)
Less than once weekly
1-3 times weekly
4-6 times weekly
Daily or more often (categories 4-5)
   Ostomy for bowel elimination M0550 Yes (categories 1-2)
No (reference category)
Neuro/Emotional/Behavioral Status:
   Cognitive functioning M0560 No impairments (reference category)
Requires prompting
Requires assistance and some direction
Requires considerable assistance
Totally dependent
   Confusion frequency M0570 Never (reference category)
New or complex situations only
On awakening or at night
Day and evening, not constantly
Constantly
   Anxiety frequency M0580 None (reference category)
Less often than daily
Daily, but not constantly
All of the time
   Verbal disruption at least once weekly M0610_3 Yes
No (reference category)
   Symptoms of depression M0590 None (reference category)
Depressed mood
Any other symptoms


TABLE 4a. Risk-Adjusters Specific to ADL Outcome Models
Variables OASIS Items Specification
ALL ACTIVITY OF DAILY LIVING OUTCOME MODELS1
Clinical Factors:
   Obesity M0290_2 Yes
No (reference category)
   Frequency of pain interfering with activity M0420 No pain, or does not interfere with activity (reference category)
Less often than daily
Daily but not constantly
All of the time
ADDITIONAL ITEM IN TRANSFERRING MODELS2
Clinical Factors:
   Current ambulation M0700 Walks independently (reference category)
Requires use of device
Able to walk only with supervision
Chairfast, able to wheel self
Chairfast, unable to wheel self
Bedfast, unable to ambulate
ADDITIONAL ITEM IN IMPROVEMENT IN AMBULATION MODEL
Clinical Factors:
   Current transferring M0700 Transfers independently (reference category)
Transfers with minimal assistance or device
Unable to transfer; can bear weight
Unable to transfer; unable to bear weight
Bedfast, able to turn and position self
  1. Improvement in Bathing, Grooming, Dressing (upper), Dressing (lower), Toileting, Transferring, Eating, and Ambulation; Stabilization in Bathing, Grooming, and Transferring.
  2. Improvement in Transferring and Stabilization in Transferring.


TABLE 4b. Risk-Adjusters Specific to IADL Outcome Models
Variables OASIS Items Specification
ALL INSTRUMENTAL ACTIVITY OF DAILY LIVING OUTCOME MODELS1
Clinical Factors:
   Behaviors demonstrated at least once a week:     
      Memory deficit M0610_1 Yes
No (reference category)
      Impaired decision-making M0610_2 Yes
No (reference category)
ADDITIONAL ITEM IN HOUSKEEPING, LAUNDRY, AND SHOPPING MODELS2
Clinical Factors:
   Obesity M0290_2 Yes
No (reference category)
   Pain frequency M0420 No pain (reference category)
Less than daily
Daily, but not constantly
All the time
  1. Improvement in Light Housekeeping, Laundry, Shopping, Light Meal Preparation, Telephone Use, Management of Medication; Stabilization in Housekeeping, Laundry, Shopping, Light Meal.
  2. Improvement in Housekeeping, Laundry, Shopping; Stabilization in Housekeeping, Laundry, Shopping.


TABLE 4c. Risk-Adjusters Specific to Physiologic Outcome Models
Variables OASIS Items Specification
ALL PSYCIOLOGIC OUTCOME MODELS EXCEPT PAIN1
Clinical Factors:
   Obesity M0290_2 Yes
No (reference category)
ADDITIONAL ITEMS IN DYSPNEA IMPROVEMENT MODEL
Clinical Factors:
   Smoking M0290_1 Yes
No (reference category)
   Respiratory treatments:    
      Oxygen M0500_1 Yes
No (reference category)
      Ventilator M0500_2 Yes
No (reference category)
ADDITIONAL ITEMS IN UTI IMPROVEMENT MODEL
Clinical Factors:
   Current ambulation M0700 Walks independently (reference category)
Requires use of device
Able to walk only with supervision
Chairfast, able to wheel self
Chairfast, unable to wheel self
Bedfast, unable to ambulate
   Therapy received in home:    
      IV/Infusion M0250_1 Yes
No (reference category)
ADDITIONAL ITEM IN INCONTINENCE MODELS2
Clinical Factors:
   Current toileting M0680 Able to get to and from the toilet independently (reference category)
Able to get to and from toilet when reminded, assisted, or supervised
Unable to get to toilet, but can use bedside commode
Unable to get to toilet or use bedside commode, but can use bedpan T
otally dependent in toileting
   Treated for UTI in past 14 days M0510 Yes
No (reference category)
ONLY OUTCOME-SPECIFIC ITEM IN IMPROVEMENT IN PAIN MODEL
Clinical Factors:
   Intractable pain M0430 Yes
No (reference category)
  1. Improvement in Number of Surgical Wounds, Status of Surgical Wounds, Dyspnea, Urinary Tract Infection, Urinary Incontinence, Bowel Incontinence, and Speech; Stabilization in Speech.
  2. Improvement in Urinary Incontinence, Bowel Incontinence.


TABLE 4d. Risk-Adjusters Specific to Cognitive and Utilization Outcomes
Variables OASIS Items Specification
ITEMS IN IMPROVEMENT IN CONFUSION FREQUENCY MODEL
Clinical Factors:
   Behaviors demonstrated at least once a week:    
      Memory deficit M0610_1 Yes
No (reference category)
      Impaired decision-making M0610_2 Yes
No (reference category)
ITEMS IN ALL UTILIZATION OUTCOME MODELS1
Clinical Factors:
   Dyspnea M0490 Never, patient is not short of breath (reference category)
Walking more than 20 feet, or on stairs
With moderate exertion
With minimal exertion
At rest
   Therapy received in home:    
      IV/Infusion M0250_1 Yes
No (reference category)
   Respiratory treatments:    
      Ventilator M0500_2 Yes
No (reference category)
  1. Acute Care Hospitalization, Discharge to Community, Emergent Care.


TABLE 5a. “Prior” Risk-Adjusters Specific to ADL Outcomes
Variables OASIS Items Specification
ITEM USED IN BATHING MODELS1
Clinical Factors:
   Bathing prior to admission M0670_P Independent (reference category)
Able with use of devices
Able with partial assistance
Requires assistance
Unable, bathed in bed/chair
Totally dependent
ITEM USED IN GROOMING MODELS2
Clinical Factors:
   Grooming prior to admission M0640_P Independent (reference category)
Able if utensils placed within reach
Able with assistance
Totally dependent
ITEM USED IN IMPROVEMENT IN UPPER BODY DRESSING MODEL
Clinical Factors:
   Dressing upper body prior to admission M0650_P Independent (reference category)
Able if clothing laid out or given
Needs some help
Totally dependent
ITEM USED IN IMPROVEMENT IN LOWER BODY DRESSING MODEL
Clinical Factors:
   Dressing lower body prior to admission M0660_P Independent (reference category)
Able if clothing laid out or given
Needs some help
Totally dependent
ITEM USED IN IMPROVEMENT IN TOILETING MODEL
Clinical Factors:
   Toileting prior to admission M0680_P Independent (reference category)
Able when assisted or supervised
Uses bedside commode
Uses bedpan independently
Totally dependent
ITEM USED IN TRANSFERRING MODELS3
Clinical Factors:
   Transferring prior to admission M0690_P Independent (reference category)
Able with minimal assistance
Unable but can pivot self
Needs assistance
Bedfast
ITEM USED IN IMPROVEMENT IN EATING MODEL
Clinical Factors:
   Eating prior to admission M0710_P Independent (reference category)
Able with intermittent assistance
Needs mechanical/personal assistance (levels 2-5)
ITEM USED IN IMPROVEMENT IN AMBULATION MODEL
Clinical Factors:
   Ambulation prior to admission M0700_P Independent (reference category)
Needs device to walk
Needs assistance to walk
Chairfast, able to wheel self
Chairfast, unable to wheel self Bedfast
  1. Improvement and Stabilization in bathing.
  2. Improvement and Stabilization in grooming.
  3. Improvement and Stabilization in transferring.


TABLE 5b. “Prior” Risk-Adjusters Specific to IADL Outcomes
Variables OASIS Items Specification
ALL INSTRUMENTAL ACTIVITY OF DAILY LIVING OUTCOME MODELS1
Clinical Factors:
   Conditions Prior to Medical Regiment:      
      Impaired decision-making M0220_4 Yes
No (reference category)
      Memory loss requiring supervision M0220_6 Yes
No (reference category)
ADDITIONAL ITEM IN HOUSEKEEPING MODELS2
Clinical Factors:
   Housekeeping prior to admission M0750_P Independent (reference category)
Light tasks only
Intermittent assistance
Usually requires assistance
Totally dependent
ADDITIONAL ITEM IN LAUNDRY MODELS3
Clinical Factors:
   Laundry prior to admission M0740_P Independent (reference category)
Light laundry only
Totally dependent
ADDITIONAL ITEM IN SHOPPING MODELS4
Clinical Factors:
   Shopping prior to admission M0760_P Independent (reference category)
Needs some assistance
Only if delivered
Totally dependent
ADDITIONAL ITEM IN LIGHT MEAL PREPARATION MODELS5
Clinical Factors:
   Meal preparation prior to admission M0720_P Independent (reference category)
Able, but not regularly
Totally dependent
ADDITIONAL ITEM IN TELEPHONE USE MODELS6
Clinical Factors:
   Telephone use prior to admission M0770_P Independent (reference category)
Able, with adapted phone
Answers, but has trouble calling
Sometimes answers, limited conversation
Can listen with assistive device
Totally dependent
ADDITIONAL ITEM IN MANAGEMENT OF MEDICATIONS MODELS7
Clinical Factors:
   Medication management prior to admission M0780_P Independent (reference category)
Able if prepared by another person
Totally dependent
  1. Improvement in Housekeeping, Laundry, Shopping, Light Meal Preparation, Telephone Use, and Medication Management; Stabilization in Housekeeping, Laundry, Shopping, Light Meal Preparation, Telephone Use, and Medication Management.
  2. Improvement and Stabilization in Housekeeping.
  3. Improvement and Stabilization in Laundry.
  4. Improvement and Stabilization in Shopping.
  5. Improvement and Stabilization in Light Meal Preparation.
  6. Improvement and Stabilization in Telephone Use.
  7. Improvement and Stabilization in Management of Medications.


TABLE 5c. “Prior” Risk-Adjusters Specific to Physiologic Outcomes
Variables OASIS Items Specification
ITEM USED IN IMPROVEMENT IN PLAN
Clinical Factors:
   Conditions Prior to Medical Regimen Change or Inpatient Stay:      
      Intractable pain M0220_3 Yes
No (reference category)
ITEMS USED IN IMPROVEMENT IN UTI, URINARY INCONTINENCE, AND BOWEL INCONTINENCE
Clinical Factors:
   Conditions Prior to Medical Regimen Change or Inpatient Stay:      
      Urinary incontinence M0220_1 Yes
No (reference category)
      Intradwelling/suprapubic catheter M0220_2 Yes
No (reference category)
ADDITIONAL ITEMS IN INCONTINENCE MODELS1
Clinical Factors:
   Conditions Prior to Medical Regimen Change or Inpatient Stay:     
      Impaired decision-making M0220_4 Yes
No (reference category)
      Memory loss requiring supervision M0220_6 Yes
No (reference category)
      Toileting M0680_P Independent (reference category)
Able when supervised
Uses bedside commode
Uses bedpan independently/totally dependent (levels 3, 4)
  1. Improvement in Urinary Incontinence and Improvement in Bowel Incontinence.


TABLE 5d. “Prior” Risk-Adjusters Specific to Emotional/Behavioral/Cognitive Outcomes
Variables OASIS Items Specification
ITEMS USED IN IMPROVEMENT IN CONFUSION FREQUENCY
Clinical Factors:
   Conditions Prior to Medical Regimen Change or Inpatient Stay:      
      Impaired decision-making M0220_2 Yes
No (reference category)
      Disruptive or socially inappropriate behavior M0220_5 Yes
No (reference category)
      Memory loss requiring supervision M0220_6 Yes
No (reference category)


TABLE 6a. Summary of Regression Models: Activities of Daily Living
Risk-Adjusted in OBQI or HHQI University of Colorado Model Model 1 Clinical Core (Baseline Model) Model 2 Adds Outcome-Specific Model 3 Adds OASIS “Prior” Items
IMPROVEMENT IN BATHING Yes  
Percent Who Could Improve: 62.2%
Percent Improving Among Those Who Could: 57.0%
Number of OASIS Items   52 41 43 44a
Number of OASIS Elements   72 59 63 64
R2 statistic   0.192 0.167 0.172 0.190
c statistic   0.755 0.738 0.741 0.753
IMPROVEMENT IN GROOMING Yes  
Percent Who Could Improve: 34.6%
Percent Improving Among Those Who Could: 61.4%
Number of OASIS Items   68 41 43 44b
Number of OASIS Elements   95 59 63 64
R2 statistic   0.238 0.200 0.201 0.220
c statistic   0.784 0.760 0.761 0.774
IMPROVEMENT IN DRESSING UPPER BODY Yes  
Percent Who Could Improve: 40.1%
Percent Improving Among Those Who Could: 61.4%
Number of OASIS Items   69 41 43 44c
Number of OASIS Elements   98 59 63 64
R2 statistic   0.233 0.193 0.194 0.215
c statistic   0.780 0.755 0.756 0.770
IMPROVEMENT IN DRESSING LOWER BODY Yes  
Percent Who Could Improve: 46.6%
Percent Improving Among Those Who Could: 60.1%
Number of OASIS Items   54 41 43 44d
Number of OASIS Elements   71 59 63 64
R2 statistic   0.210 0.182 0.182 0.201
c statistic   0.763 0.744 0.745 0.758
IMPROVEMENT IN TOILETING Yes  
Percent Who Could Improve: 24.5%
Percent Improving Among Those Who Could: 59.7%
Number of OASIS Items   43 41 43 44e
Number of OASIS Elements   59 59 63 64
R2 statistic   0.267 0.224 0.226 0.245
c statistic   0.800 0.775 0.775 0.787
IMPROVEMENT IN TRANSFERRING Yes  
Percent Who Could Improve: 46.3%
Percent Improving Among Those Who Could: 49.8%
Number of OASIS Items   60 41 43 44f
Number of OASIS Elements   87 59 63 64
R2 statistic   0.137 0.102 0.112 0.129
c statistic   0.711 0.681 0.690 0.705
IMPROVEMENT IN EATING Yes  
Percent Who Could Improve: 21.6%
Percent Improving Among Those Who Could: 53.3%
Number of OASIS Items   42 41 43 44g
Number of OASIS Elements   60 59 63 64
R2 statistic   0.176 0.150 0.150 0.167
c statistic   0.742 0.723 0.724 0.737
IMPROVEMENT IN AMBULATION Yes  
Percent Who Could Improve: 59.9%
Percent Improving Among Those Who Could: 34.1%
Number of OASIS Items   38 41 43 44h
Number of OASIS Elements   53 59 63 64
R2 statistic   0.180 0.213 0.222 0.244
c statistic   0.755 0.768 0.775 0.788
STABILIZATION IN BATHING Yes  
Percent Who Could Stabilize: 66.4%
Percent Stabilized Among Those Who Could: 90.4%
Number of OASIS Items   42 41 43 44a
Number of OASIS Elements   55 59 63 64
R2 statistic   0.114 0.098 0.104 0.105
c statistic   0.786 0.772 0.776 0.778
STABILIZATION IN GROOMING Yes  
Percent Who Could Stabilize: 65.4%
Percent Stabilized Among Those Who Could: 93.2%
Number of OASIS Items   44 41 43 44b
Number of OASIS Elements   64 59 63 64
R2 statistic   0.113 0.096 0.096 0.097
c statistic   0.804 0.784 0.784 0.786
STABILIZATION IN TRANSFERRING Yes  
Percent Who Could Stabilize: 69.2%
Percent Stabilized Among Those Who Could: 93.7%
Number of OASIS Items   48 41 43 44f
Number of OASIS Elements   70 59 63 64
R2 statistic   0.118 0.088 0.103 0.104
c statistic   0.846 0.815 0.836 0.836
NOTES: “Percent Who Could Improve” calculated using all home health episodes, not just those discharged to the community. The smallest sample size for the ADL risk-adjustment models is 54,030. Shading indicates that U of CO model statistics are for multiple sub-models; we report the number of unique OASIS items and elements across all sub-models.
  1. Risk-adjustment model includes help required with bathing prior to home health admission.
  2. Risk-adjustment model includes help required with grooming prior to home health admission.
  3. Risk-adjustment model includes help required with dressing upper body prior to home health admission.
  4. Risk-adjustment model includes help required with dressing lower body prior to home health admission.
  5. Risk-adjustment model includes help required with using the toilet prior to home health admission.
  6. Risk-adjustment model includes help required with transferring prior to home health admission.
  7. Risk-adjustment model includes help required with eating prior to home health admission.
  8. Risk-adjustment model includes help required with ambulating prior to home health admission.


TABLE 6b. Final Alternative Risk-Adjustment Models for Activities of Daily Living Outcomes (Part I)
Risk Factor Measured at SOC/ROC Improvement in:
Bathing Grooming Dressing Upper Body Dressing Lower Body Toileting Transferring
Full Model Full Model Full Model Full Model Full Model Full Model
Coef. p Coef. p Coef. p Coef. p Coef. p Coef. p
DEMOGRAPHICS
Age lt 65  -0.031   0.337   -0.117   0.000   -0.146   0.000   -0.051   0.170   -0.125   0.025   -0.026   0.310 
Age 75-84 -0.062 0.004 0.014 0.516 0.008 0.695 0.047 0.063 0.059 0.118 -0.059 0.000
Age 85+ -0.302 0.000 -0.178 0.000 -0.161 0.000 -0.112 0.000 -0.110 0.008 -0.252 0.000
Gender: female -0.116 0.000 -0.004 0.800 0.001 0.969 0.083 0.000 -0.106 0.000 -0.030 0.035
SOCIOECONOMIC FACTORS
Any Medicaid -0.170 0.000 -0.221 0.000 -0.173 0.000 -0.151 0.000 -0.220 0.000 -0.169 0.000
Medicare HMO -0.110 0.000 -0.051 0.062 -0.072 0.004 -0.132 0.000 -0.072 0.107 -0.097 0.000
PRIOR SERVICE USE
Discharged past 14 days:
Discharge from hospital 0.348 0.000 0.419 0.000 0.436 0.000 0.391 0.000 0.444 0.000 0.310 0.000
Discharge from rehab facility 0.331 0.000 0.538 0.000 0.518 0.000 0.437 0.000 0.452 0.000 0.256 0.000
Discharge from nursing home 0.309 0.000 0.495 0.000 0.482 0.000 0.412 0.000 0.281 0.000 0.161 0.000
CLINICAL FACTORS
Prognoses
Overall prognosis good/fair 0.280 0.000 0.306 0.000 0.312 0.000 0.353 0.000 0.333 0.000 0.279 0.000
Rehabilitation prognosis good 0.313 0.000 0.330 0.000 0.334 0.000 0.296 0.000 0.307 0.000 0.261 0.000
Diagnoses
Diabetes (PPS Group) -0.069 0.001 -0.041 0.052 -0.052 0.008 -0.076 0.003 -0.048 0.187 -0.073 0.000
Orthopedic (PPS Group) -0.003 0.865 0.210 0.000 0.140 0.000 0.070 0.001 0.135 0.000 0.077 0.000
Neurological (PPS Group) -0.148 0.000 -0.142 0.000 -0.192 0.000 -0.187 0.000 -0.214 0.000 -0.096 0.000
Wound/Burn (PPS Group) -0.133 0.001 -0.220 0.000 -0.172 0.000 -0.123 0.010 -0.200 0.004 -0.115 0.000
Cancer -0.120 0.000 -0.201 0.000 -0.227 0.000 -0.123 0.001 -0.233 0.000 -0.076 0.005
Mental condition 0.006 0.888 0.011 0.778 0.039 0.316 0.080 0.122 -0.008 0.911 0.099 0.006
Dementia -0.169 0.001 -0.126 0.002 -0.160 0.000 -0.126 0.018 -0.142 0.024 0.021 0.583
Hypertension 0.081 0.000 0.050 0.008 0.054 0.002 0.072 0.001 0.005 0.888 -0.029 0.052
Ischemia 0.127 0.000 0.162 0.000 0.182 0.000 0.142 0.000 0.108 0.032 0.167 0.000
Arrhythmia 0.068 0.022 0.079 0.008 0.049 0.072 0.047 0.194 0.035 0.505 -0.033 0.165
Heart failure -0.092 0.000 -0.080 0.001 -0.037 0.104 -0.073 0.014 0.027 0.523 -0.090 0.000
COPD -0.099 0.000 -0.016 0.548 -0.005 0.857 -0.017 0.606 0.081 0.101 0.031 0.172
Skin ulcer -0.153 0.000 -0.172 0.000 -0.139 0.000 -0.120 0.011 -0.178 0.006 -0.192 0.000
Orthopedic (other than PPS) 0.043 0.042 0.194 0.000 0.214 0.000 0.024 0.336 0.178 0.000 -0.056 0.000
Incontinence -0.279 0.000 -0.185 0.000 -0.168 0.000 -0.181 0.003 -0.171 0.016 -0.200 0.000
Symptoms, signs, & ill-defined conditions -0.068 0.016 -0.024 0.357 0.003 0.896 -0.003 0.926 -0.153 0.000 -0.024 0.283
Diagnosis Severity
Number of severity ratings >2 0.038 0.000 0.006 0.338 0.031 0.000 0.048 0.000 0.031 0.004 0.014 0.006
Sensory Status
Partially vision impaired -0.053 0.007 -0.135 0.000 -0.085 0.000 -0.056 0.012 -0.083 0.005 -0.102 0.000
Severely vision impaired -0.140 0.008 -0.392 0.000 -0.307 0.000 -0.143 0.013 -0.166 0.019 -0.116 0.005
Speech: Minimum difficulty -0.038 0.109 -0.110 0.000 -0.069 0.001 -0.035 0.203 -0.048 0.195 -0.064 0.001
Speech: Moderate difficulty -0.093 0.025 -0.214 0.000 -0.170 0.000 -0.144 0.001 -0.079 0.143 -0.102 0.002
Speech: Severe difficulty -0.381 0.000 -0.620 0.000 -0.539 0.000 -0.476 0.000 -0.373 0.000 -0.308 0.000
Integumentary Status
Surgical wound present 0.312 0.000 0.361 0.000 0.385 0.000 0.188 0.000 0.341 0.000 0.202 0.000
Stage of most problematic pressure ulcer -0.141 0.000 -0.158 0.000 -0.162 0.000 -0.182 0.000 -0.159 0.000 -0.128 0.000
Status of most problematic stasis ulcer -0.155 0.000 -0.066 0.007 -0.111 0.000 -0.170 0.000 -0.139 0.002 -0.077 0.000
Functional Status/Physical Functioning
ADL/IADL index -0.125 0.000 -0.236 0.000 -0.247 0.000 -0.239 0.000 -0.300 0.000 -0.090 0.000
Bath: Able 2/use of devices                        
Bath: Able w/partial assistance 1.087 0.000                    
Bath: Requires assistance 2.217 0.000                    
Bath: Unable, Bathed in bed/chair 2.355 0.000                    
Bath: Totally dependent 3.538 0.000                    
Groom: Utensils within reach                        
Groom: With assistance     1.111 0.000                
Groom: Totally dependent     2.105 0.000                
Dress UB: Needs some help         0.925 0.000            
Dress UB: Totally dependent         2.068 0.000            
Dress LB: Needs some help             0.644 0.000        
Dress LB: Totally dependent             1.979 0.000        
Toilet: Uses bedside commode                 0.727 0.000    
Toilet: Uses bedpan independently                 1.027 0.000    
Toilet: Totally dependent                 1.260 0.000    
Transfer: Able w/minimal assistance -0.030 0.180                    
Transfer: Unable buy pivots -0.309 0.000                 2.208 0.000
Transfer: Needs assistance -0.687 0.000                 2.708 0.000
Transfer: Needs assistance/bedfast, able to turn self                        
Transfer: Bedfact (Levels 4, 5) -1.114 0.000                 3.061 0.000
Eat: Unable to feed self                        
Eat: Food tube/unable to take in nutrients (Levels 3-5)                        
Amb: Needs device to walk                     -0.691 0.000
Amb: Needs assistance to walk                     -0.816 0.000
Amb: Chairfast, Able to wheel                     -1.456 0.000
Amb: Chairfast, Unable to wheel                     -1.717 0.000
Amb: Bedfast                     -2.148 0.000
Elimination Status
Urinary incontinence during the night -0.097 0.002 -0.094 0.001 -0.108 0.000 -0.094 0.009 -0.127 0.009 -0.132 0.000
Urinary incontinence during the day -0.152 0.006 -0.132 0.006 -0.169 0.000 -0.134 0.028 -0.208 0.006 -0.218 0.000
Urinary incontinence during the night & day -0.212 0.000 -0.213 0.000 -0.216 0.000 -0.219 0.000 -0.224 0.000 -0.222 0.000
Urinary catheter present -0.258 0.000 -0.441 0.000 -0.430 0.000 -0.479 0.000 -0.754 0.000 -0.386 0.000
Bowel incontinent less than weekly -0.053 0.306 -0.060 0.164 -0.037 0.373 -0.115 0.042 -0.050 0.456 -0.123 0.002
Bowel incontinent 1-3 times/week -0.175 0.000 -0.236 0.000 -0.210 0.000 -0.316 0.000 -0.279 0.000 -0.166 0.000
Bowel incontinent 4-6 times/week -0.266 0.000 -0.384 0.000 -0.350 0.000 -0.399 0.000 -0.462 0.000 -0.327 0.000
c statistic -0.259 0.000 -0.487 0.000 -0.485 0.000 -0.514 0.000 -0.499 0.000 -0.234 0.000
Ostomy 0.015 0.809 -0.092 0.124 -0.025 0.651 0.048 0.501 -0.270 0.007 0.061 0.223
Neuro/Emotional/Behavioral Status
Cog Func: Requires prompting -0.080 0.002 -0.065 0.008 -0.067 0.003 -0.048 0.112 -0.096 0.021 -0.074 0.000
Cog Func: Requires assistance & some direction -0.130 0.001 -0.161 0.000 -0.118 0.000 -0.096 0.032 -0.179 0.002 -0.082 0.011
Cog Func: Requires considerable assistance -0.177 0.007 -0.215 0.000 -0.121 0.016 -0.164 0.019 -0.142 0.075 -0.083 0.097
Cog Func: Totally dependent -0.572 0.000 -0.514 0.000 -0.497 0.000 -0.688 0.000 -0.360 0.014 -0.300 0.001
Conf Freq: In new situations -0.035 0.122 -0.065 0.004 -0.038 0.062 -0.003 0.921 -0.024 0.525 -0.048 0.008
Conf Freq: Awakening at night -0.077 0.225 -0.038 0.482 -0.103 0.041 -0.147 0.034 -0.004 0.960 -0.014 0.777
Conf Freq: Day/evenings, not constant -0.127 0.001 -0.215 0.000 -0.180 0.000 -0.106 0.016 -0.054 0.331 -0.009 0.769
Conf Freq: Constantly -0.178 0.018 -0.376 0.000 -0.350 0.000 -0.219 0.007 -0.119 0.185 0.051 0.369
Anx Freq: Less than daily -0.016 0.437 -0.006 0.774 -0.005 0.803 -0.047 0.053 0.052 0.132 -0.005 0.750
Anx Freq: Daily but not constantly 0.018 0.466 0.022 0.344 0.031 0.152 0.034 0.244 0.130 0.001 0.029 0.139
Anx Freq: All the time 0.135 0.048 0.066 0.296 0.142 0.018 0.070 0.379 0.132 0.229 0.161 0.003
Verbal disruption -0.232 0.003 -0.263 0.000 -0.255 0.000 -0.256 0.002 -0.215 0.019 -0.133 0.023
Depressive Feelings: Depressed mood -0.062 0.004 -0.030 0.141 -0.026 0.168 -0.035 0.168 -0.101 0.003 -0.023 0.182
Depressive Feelings: Any other elements (2-6) -0.037 0.493 0.018 0.691 0.003 0.937 -0.027 0.648 -0.097 0.204 -0.087 0.037
OUTCOME SPECIFIC RISK-ADJUSTERS
Obesity -0.082 0.001 0.004 0.865 -0.038 0.092 -0.166 0.000 -0.039 0.353 -0.133 0.000
Pain less often daily -0.032 0.237 0.022 0.404 0.024 0.314 -0.014 0.673 -0.014 0.756 -0.009 0.665
Pain daily but not constantly 0.060 0.002 0.106 0.000 0.068 0.000 0.021 0.360 0.112 0.001 -0.013 0.393
Pain all the time 0.070 0.032 0.095 0.003 0.054 0.069 -0.013 0.740 0.229 0.000 0.010 0.698
Status Prior to Admission
Bath: Able w/use of devices -0.270 0.000                    
Bath: Able w/partial assistance -0.721 0.000                    
Bath: Requires assistance -0.861 0.000                    
Bath: Unable, Bathed in bed/chair -0.877 0.000                    
Bath: Totally dependent -0.925 0.000                    
Groom: If utensils placed within reach     -0.688 0.000                
Groom: With assistance     -0.890 0.000                
Groom: Totally dependent     -1.086 0.000                
Dress UB: Able if clothing out         -0.667 0.000            
Dress UB: Needs some help         -0.897 0.000            
Dress UB: Totally dependent         -1.084 0.000            
Dress LB: Able if laid out or given             -0.501 0.000        
Dress LB: Needs some help             -0.793 0.000        
Dress LB: Totally dependent             -0.974 0.000        
Toilet: Able when supervised                 -0.756 0.000    
Toilet: Uses bedside commode                 -0.818 0.000    
Toilet: Uses bedpan independently                 -0.670 0.000    
Toilet: Totally dependent                 -1.164 0.000    
Transfer: Able w/minimal assistance                     -0.600 0.000
Transfer: Unable but pivots                     -0.888 0.000
Transfer: Needs assistance                     -1.056 0.000
Transfer: Needs assistance/bedfast (Levels 3,4)                        
Transfer: Bedfast (Levels 4,5)                     -0.946 0.000
Eat: Able with intermittent assistance                        
Eat: Needs mechanical/personal assistance                        
Amb: Needs device to walk                        
Amb: Needs assistance to walk                        
Amb: Chairfast, Able to wheel                        
Amb: Chairfast, Unable wheel                        
Amb: Bedfast                        
 
Intercept -0.414 0.000 1.839 0.000 1.746 0.000 1.387 0.000 3.079 0.000 1.189 0.000
R2 statistic 0.190   0.220   0.215   0.201   0.245   0.129  
c statistic 0.753   0.774   0.770   0.758   0.787   0.705  


TABLE 6b. Final Alternative Risk-Adjustment Models for Activities of Daily Living Outcomes (Part II)
Risk Factor Measured at SOC/ROC Improvement in: Stabilization in:
Eating Ambulation Bathing Grooming Transferring
Full Model Full Model Full Model Full Model Full Model
Coef. p Coef. p Coef. p Coef. p Coef. p
DEMOGRAPHICS
Age lt 65  0.038   0.469   -0.061   0.081   0.223   0.000   0.069   0.253   0.152   0.011 
Age 75-84 0.078 0.033 -0.101 0.000 -0.111 0.001 0.033 0.411 -0.045 0.261
Age 85+ -0.097 0.018 -0.363 0.000 -0.306 0.000 -0.231 0.000 -0.206 0.000
Gender: female 0.037 0.198 -0.127 0.000 -0.140 0.000 -0.029 0.360 -0.101 0.002
SOCIOECONOMIC FACTORS
Any Medicaid -0.264 0.000 -0.040 0.231 0.038 0.417 -0.072 0.191 -0.038 0.485
Medicare HMO -0.055 0.235 -0.167 0.000 -0.127 0.001 -0.136 0.004 -0.110 0.024
PRIOR SERVICE USE
Discharged past 14 days:
Discharge from hospital 0.365 0.000 0.249 0.000 0.094 0.002 0.220 0.000 0.174 0.000
Discharge from rehab facility 0.522 0.000 -0.107 0.000 0.046 0.305 0.293 0.000 -0.072 0.182
Discharge from nursing home 0.372 0.000 -0.103 0.003 0.060 0.235 0.303 0.000 0.169 0.007
CLINICAL FACTORS
Prognoses
Overall prognosis good/fair 0.155 0.003 0.285 0.000 0.422 0.000 0.329 0.000 0.368 0.000
Rehabilitation prognosis good 0.149 0.000 0.379 0.000 0.272 0.000 0.368 0.000 0.333 0.000
Diagnoses
Diabetes (PPS Group) 0.047 0.188 -0.118 0.000 -0.089 0.007 -0.084 0.032 -0.048 0.231
Orthopedic (PPS Group) 0.227 0.000 -0.183 0.000 -0.008 0.794 0.134 0.000 0.083 0.023
Neurological (PPS Group) -0.099 0.004 -0.272 0.000 -0.082 0.021 -0.120 0.003 -0.051 0.237
Wound/Burn (PPS Group) -0.096 0.146 -0.021 0.630 -0.214 0.000 -0.233 0.001 -0.119 0.092
Cancer -0.295 0.000 0.144 0.000 -0.360 0.000 -0.512 0.000 -0.318 0.000
Mental condition -0.015 0.828 0.101 0.039 0.053 0.407 -0.095 0.189 0.157 0.043
Dementia -0.025 0.700 0.000 0.993 -0.089 0.198 -0.158 0.034 0.072 0.369
Hypertension -0.006 0.841 0.016 0.432 0.085 0.004 0.131 0.000 0.003 0.925
Ischemia 0.034 0.463 0.294 0.000 0.121 0.004 0.251 0.000 0.219 0.000
Arrhythmia 0.000 0.995 0.035 0.285 0.031 0.497 -0.006 0.918 0.039 0.476
Heart failure -0.047 0.256 -0.103 0.000 -0.129 0.001 -0.040 0.367 -0.046 0.318
COPD 0.094 0.043 0.012 0.698 -0.081 0.053 -0.107 0.027 0.006 0.907
Skin ulcer -0.021 0.746 -0.170 0.000 -0.230 0.000 -0.165 0.015 -0.222 0.001
Orthopedic (other than PPS) 0.067 0.065 -0.398 0.000 0.026 0.449 0.290 0.000 0.022 0.605
Incontinence -0.076 0.312 -0.154 0.017 -0.172 0.045 -0.149 0.107 -0.126 0.173
Symptoms, signs, & ill-defined conditions -0.026 0.568 -0.102 0.001 -0.010 0.827 0.032 0.521 -0.055 0.296
Diagnosis Severity
Number of severity ratings >2 0.004 0.731 0.084 0.000 0.009 0.360 -0.023 0.053 -0.010 0.395
Sensory Status
Partially vision impaired -0.217 0.000 -0.063 0.005 0.059 0.052 -0.088 0.011 -0.084 0.021
Severely vision impaired -0.300 0.000 -0.285 0.000 -0.006 0.937 -0.452 0.000 -0.173 0.048
Speech: Minimum difficulty -0.173 0.000 -0.034 0.213 0.025 0.497 -0.085 0.042 -0.052 0.252
Speech: Moderate difficulty -0.261 0.000 -0.064 0.178 -0.131 0.036 -0.343 0.000 -0.276 0.000
Speech: Severe difficulty -0.572 0.000 -0.285 0.000 -0.365 0.000 -0.576 0.000 -0.229 0.011
Integumentary Status
Surgical wound present 0.278 0.000 0.194 0.000 0.329 0.000 0.484 0.000 0.401 0.000
Stage of most problematic pressure ulcer -0.127 0.000 -0.204 0.000 -0.151 0.000 -0.156 0.000 -0.178 0.000
Status of most problematic stasis ulcer -0.035 0.400 -0.079 0.006 -0.094 0.004 -0.093 0.016 -0.081 0.040
Functional Status/Physical Functioning
ADL/IADL index -0.142 0.000 -0.093 0.000 -0.228 0.000 -0.349 0.000 -0.185 0.000
Bath: Able 2/use of devices         1.066 0.000        
Bath: Able w/partial assistance         2.328 0.000        
Bath: Requires assistance         3.595 0.000        
Bath: Unable, Bathed in bed/chair         4.679 0.000        
Bath: Totally dependent                    
Groom: Utensils within reach             1.185 0.000    
Groom: With assistance             2.994 0.000    
Groom: Totally dependent                    
Dress UB: Needs some help                    
Dress UB: Totally dependent                    
Dress LB: Needs some help                    
Dress LB: Totally dependent                    
Toilet: Uses bedside commode                    
Toilet: Uses bedpan independently                    
Toilet: Totally dependent                    
Transfer: Able w/minimal assistance     -0.498 0.000 -0.085 0.014     3.513 0.000
Transfer: Unable buy pivots     -0.866 0.000 -0.619 0.000     4.090 0.000
Transfer: Needs assistance     -1.203 0.000 -1.078 0.000        
Transfer: Needs assistance/bedfast, able to turn self                 4.337 0.000
Transfer: Bedfact (Levels 4, 5)     -1.654 0.000 -1.736 0.000        
Eat: Unable to feed self 1.392 0.000                
Eat: Food tube/unable to take in nutrients (Levels 3-5) 0.642 0.000                
Amb: Needs device to walk                 -1.086 0.000
Amb: Needs assistance to walk     3.397 0.000         -1.463 0.000
Amb: Chairfast, Able to wheel     2.884 0.000         -2.074 0.000
Amb: Chairfast, Unable to wheel     4.133 0.000         -2.706 0.000
Amb: Bedfast     4.841 0.000         -2.681 0.000
Elimination Status
Urinary incontinence during the night 0.034 0.495 -0.173 0.000 0.010 0.839 -0.092 0.088 -0.127 0.029
Urinary incontinence during the day -0.176 0.029 -0.224 0.001 -0.009 0.918 -0.128 0.169 -0.060 0.579
Urinary incontinence during the night & day -0.087 0.025 -0.235 0.000 -0.026 0.516 -0.159 0.000 -0.192 0.000
Urinary catheter present -0.257 0.000 -0.380 0.000 -0.243 0.000 -0.366 0.000 -0.383 0.000
Bowel incontinent less than weekly -0.201 0.006 -0.099 0.104 -0.204 0.008 -0.028 0.746 -0.210 0.022
Bowel incontinent 1-3 times/week -0.198 0.001 -0.114 0.031 -0.148 0.046 -0.135 0.082 -0.194 0.016
Bowel incontinent 4-6 times/week -0.385 0.000 -0.277 0.000 -0.392 0.000 -0.488 0.000 -0.184 0.095
c statistic -0.267 0.000 -0.324 0.000 -0.446 0.000 -0.535 0.000 -0.200 0.018
Ostomy 0.043 0.675 0.323 0.000 -0.234 0.008 -0.118 0.261 0.038 0.729
Neuro/Emotional/Behavioral Status
Cog Func: Requires prompting -0.080 0.053 -0.056 0.062 0.019 0.634 -0.077 0.089 0.031 0.540
Cog Func: Requires assistance & some direction -0.121 0.035 -0.068 0.151 0.057 0.365 -0.168 0.012 0.045 0.542
Cog Func: Requires considerable assistance -0.146 0.077 -0.103 0.164 0.114 0.259 -0.140 0.198 0.001 0.995
Cog Func: Totally dependent -0.395 0.007 -0.298 0.028 -0.404 0.051 -0.818 0.003 -0.240 0.191
Conf Freq: In new situations -0.007 0.846 0.018 0.488 -0.108 0.002 -0.076 0.062 0.028 0.526
Conf Freq: Awakening at night -0.065 0.467 0.036 0.627 -0.273 0.005 -0.201 0.056 0.003 0.980
Conf Freq: Day/evenings, not constant -0.074 0.199 -0.014 0.766 -0.233 0.000 -0.336 0.000 0.019 0.793
Conf Freq: Constantly -0.211 0.024 0.034 0.690 -0.332 0.003 -0.525 0.000 0.186 0.132
Anx Freq: Less than daily -0.019 0.580 0.011 0.648 0.007 0.817 0.025 0.499 0.043 0.271
Anx Freq: Daily but not constantly -0.053 0.175 0.106 0.000 0.024 0.538 0.062 0.167 0.145 0.002
Anx Freq: All the time 0.054 0.606 0.166 0.028 0.019 0.856 0.059 0.619 -0.080 0.475
Verbal disruption -0.153 0.108 -0.001 0.987 -0.154 0.166 -0.412 0.000 -0.176 0.124
Depressive Feelings: Depressed mood 0.031 0.375 -0.045 0.064 -0.033 0.337 -0.068 0.072 -0.102 0.010
Depressive Feelings: Any other elements (2-6) -0.079 0.296 -0.067 0.269 0.086 0.299 0.044 0.625 -0.062 0.514
OUTCOME SPECIFIC RISK-ADJUSTERS
Obesity 0.058 0.175 -0.126 0.000 -0.094 0.015 -0.006 0.901 -0.109 0.018
Pain less often daily 0.041 0.342 -0.086 0.005 0.023 0.560 0.046 0.339 -0.119 0.015
Pain daily but not constantly 0.013 0.698 -0.052 0.016 0.090 0.003 0.121 0.001 -0.053 0.139
Pain all the time 0.078 0.159 -0.022 0.535 0.111 0.038 0.158 0.010 -0.052 0.399
Status Prior to Admission
Bath: Able w/use of devices         -0.151 0.001        
Bath: Able w/partial assistance         -0.452 0.000        
Bath: Requires assistance         -0.259 0.000        
Bath: Unable, Bathed in bed/chair         -0.559 0.000        
Bath: Totally dependent         -0.065 0.740        
Groom: If utensils placed within reach             -0.452 0.000    
Groom: With assistance             -0.424 0.000    
Groom: Totally dependent             -0.410 0.011    
Dress UB: Able if clothing out                    
Dress UB: Needs some help                    
Dress UB: Totally dependent                    
Dress LB: Able if laid out or given                    
Dress LB: Needs some help                    
Dress LB: Totally dependent                    
Toilet: Able when supervised                    
Toilet: Uses bedside commode                    
Toilet: Uses bedpan independently                    
Toilet: Totally dependent                    
Transfer: Able w/minimal assistance                 -0.352 0.000
Transfer: Unable but pivots                 -0.510 0.000
Transfer: Needs assistance                    
Transfer: Needs assistance/bedfast (Levels 3,4)                 -0.457 0.000
Transfer: Bedfast (Levels 4,5)                    
Eat: Able with intermittent assistance -0.658 0.000                
Eat: Needs mechanical/personal assistance -0.921 0.000                
Amb: Needs device to walk     -0.674 0.000            
Amb: Needs assistance to walk     -1.048 0.000            
Amb: Chairfast, Able to wheel     -1.881 0.000            
Amb: Chairfast, Unable wheel     -1.654 0.000            
Amb: Bedfast     -1.074 0.000            
 
Intercept 1.472 0.000 -0.389 0.000 1.307 0.000 3.774 0.000 3.019 0.000
R2 statistic 0.167   0.244   0.105   0.097   0.104  
c statistic 0.737   0.788   0.778   0.786   0.836  


TABLE 7a. Summary of Regression Models: Instrumental Activities of Daily Living
  Risk-Adjusted in OBQI or HHQI University of Colorado Model Model 1 Clinical Core (Baseline Model) Model 2 Adds Outcome-Specific Model 3 Adds OASIS “Prior” Items
IMPROVEMENT IN HOUSINGKEEPING Yes  
Percent Who Could Improve: 68.6%
Percent Improving Among Those Who Could: 44.2%
Number of OASIS Items   48 41 43 46a
Number of OASIS Elements   74 59 65 70
R2 statistic   0.263 0.254 0.254 0.273
c statistic   0.798 0.792 0.793 0.803
IMPROVEMENT IN LAUNDRY Yes  
Percent Who Could Improve: 67.6%
Percent Improving Among Those Who Could: 37.1%
Number of OASIS Items   47 41 43 46b
Number of OASIS Elements   76 59 65 70
R2 statistic   0.264 0.220 0.221 0.246
c statistic   0.805 0.779 0.779 0.794
IMPROVEMENT IN SHOPPING Yes  
Percent Who Could Improve: 69.3%
Percent Improving Among Those Who Could: 47.1%
Number of OASIS Items   46 41 43 46c
Number of OASIS Elements   64 59 65 70
R2 statistic   0.226 0.204 0.204 0.222
c statistic   0.775 0.759 0.760 0.772
IMPROVEMENT IN LIGHT MEAL PREPARATION Yes  
Percent Who Could Improve: 50.9%
Percent Improving Among Those Who Could: 52.4%
Number of OASIS Items   51 41 41 44d
Number of OASIS Elements   79 59 61 66
R2 statistic   0.267 0.215 0.216 0.236
c statistic   0.797 0.766 0.767 0.779
IMPROVEMENT IN TELEPHONE USE Yes  
Percent Who Could Improve: 18.1%
Percent Improving Among Those Who Could: 47.1%
Number of OASIS Items   70 41 41 44e
Number of OASIS Elements   97 59 61 66
R2 statistic   0.124 0.106 0.106 0.116
c statistic   0.702 0.686 0.687 0.695
IMPROVEMENT IN MEDICATION MANAGEMENT Yes  
Percent Who Could Improve: 38.7%
Percent Improving Among Those Who Could: 34.8%
Number of OASIS Items   48 41 41 44f
Number of OASIS Elements   76 59 61 66
R2 statistic   0.180 0.132 0.133 0.157
c statistic   0.754 0.718 0.720 0.737
STABILIZATION IN HOUSEKEEPING Yes  
Percent Who Could Stabilize: 31.3%
Percent Stabilized Among Those Who Could: 82.3%
Number of OASIS Items   50 41 43 46a
Number of OASIS Elements   71 59 65 70
R2 statistic   0.110 0.088 0.089 0.095
c statistic   0.721 0.699 0.699 0.706
STABILIZATION IN LAUNDRY Yes  
Percent Who Could Stabilize: 17.2%
Percent Stabilized Among Those Who Could: 83.1%
Number of OASIS Items   46 41 43 46b
Number of OASIS Elements   68 59 65 70
R2 statistic   0.133 0.114 0.115 0.120
c statistic   0.752 0.732 0.732 0.739
STABILIZATION IN SHOPPING Yes  
Percent Who Could Stabilize: 44.1%
Percent Stabilized Among Those Who Could: 89.2%
Number of OASIS Items   41 41 43 46c
Number of OASIS Elements   56 59 65 70
R2 statistic   0.120 0.109 0.109 0.116
c statistic   0.776 0.761 0.762 0.771
STABILIZATION IN LIGHT MEAL PREPARATION Yes  
Percent Who Could Stabilize: 44.3%
Percent Stabilized Among Those Who Could: 90.1%
Number of OASIS Items   43 41 41 44d
Number of OASIS Elements   69 59 61 66
R2 statistic   0.118 0.086 0.086 0.091
c statistic   0.777 0.735 0.736 0.742
STABILIZATION IN TELEPHONE USE Yes  
Percent Who Could Stabilize: 66.7%
Percent Stabilized Among Those Who Could: 92.6%
Number of OASIS Items   45 41 41 44e
Number of OASIS Elements   66 59 61 66
R2 statistic   0.103 0.091 0.092 0.092
c statistic   0.803 0.788 0.788 0.789
STABILIZATION IN MEDICATION MANAGEMENT No  
Percent Who Could Stabilize: 54.8%
Percent Stabilized Among Those Who Could: 91.7%
Number of OASIS Items   N/A 41 41 44f
Number of OASIS Elements     59 61 66
R2 statistic     0.064 0.064 0.066
c statistic     0.728 0.728 0.732
NOTES: “Percent Who Could Improve” calculated using all home health episodes, not just those discharged to the community. The smallest sample size for the IADL risk-adjustment models is 42,946. Shading indicates that CO model statistics are for multiple sub-models; we report the number of unique OASIS items and elements across all sub-models.
  1. Risk-adjustment model includes help required with housekeeping, impaired decision making and memory loss prior to home health admission.
  2. Risk-adjustment model includes help required with laundry, impaired decision making, and memory loss prior to home health admission.
  3. Risk-adjustment model includes help required with shopping, impaired decision making, and memory loss prior to home health admission.
  4. Risk-adjustment model includes help required with light meal preparation, impaired decision making and memory loss prior to home health admission.
  5. Risk-adjustment model includes help required with telephone use, impaired decision making, and memory loss prior to home health admission.
  6. Risk-adjustment model includes help required with taking oral medication(s), impaired decision making and memory loss prior to home health admission.


TABLE 7b. Final Alternative Risk-Adjustment Models for Instrumental Activities of Daily Living Outcomes (Part I)
Risk Factor Measured at SOC/ROC Improvement in:
Housekeeping Laundry Shopping Light Meal Prep. Telephone Use Medication Mgmt.
Full Model Full Model Full Model Full Model Full Model Full Model
Coef. p Coef. p Coef. p Coef. p Coef. p Coef. p
DEMOGRAPHICS
Age lt 65  0.052   0.018   0.075   0.016   0.124   0.000   -0.113   0.002   -0.120   0.000   0.014   0.660 
Age 75-84 -0.024 0.111 -0.019 0.368 -0.105 0.000 -0.055 0.022 -0.053 0.017 -0.182 0.000
Age 85+ -0.294 0.000 -0.362 0.000 -0.357 0.000 -0.328 0.000 -0.244 0.000 -0.501 0.000
Gender: female 0.207 0.000 0.239 0.000 -0.073 0.000 0.199 0.000 0.060 0.000 0.089 0.000
SOCIOECONOMIC FACTORS
Any Medicaid -0.136 0.000 -0.173 0.000 -0.104 0.000 -0.171 0.000 -0.211 0.000 -0.127 0.000
Medicare HMO -0.196 0.000 -0.314 0.000 -0.207 0.000 -0.174 0.000 0.084 0.001 -0.038 0.129
PRIOR SERVICE USE
Discharged past 14 days:
Discharge from hospital 0.319 0.000 0.304 0.000 0.281 0.000 0.381 0.000 0.351 0.000 0.317 0.000
Discharge from rehab facility 0.405 0.000 0.336 0.000 0.328 0.000 0.517 0.000 0.500 0.000 0.409 0.000
Discharge from nursing home 0.308 0.000 0.260 0.000 0.218 0.000 0.395 0.000 0.297 0.000 0.203 0.000
CLINICAL FACTORS
Prognoses
Overall prognosis good/fair 0.319 0.000 0.275 0.000 0.337 0.000 0.268 0.000 0.213 0.000 0.271 0.000
Rehabilitation prognosis good 0.285 0.000 0.341 0.000 0.282 0.000 0.225 0.000 0.086 0.000 0.150 0.000
Diagnoses
Diabetes (PPS Group) -0.067 0.000 -0.041 0.064 0.017 0.419 -0.053 0.029 0.031 0.107 -0.080 0.000
Orthopedic (PPS Group) 0.067 0.000 -0.017 0.373 0.025 0.164 0.129 0.000 0.137 0.000 0.062 0.000
Neurological (PPS Group) -0.096 0.000 -0.155 0.000 -0.016 0.483 -0.132 0.000 -0.088 0.000 -0.255 0.000
Wound/Burn (PPS Group) -0.051 0.063 0.015 0.703 -0.032 0.404 -0.133 0.003 -0.062 0.097 -0.080 0.041
Cancer -0.219 0.000 -0.242 0.000 -0.185 0.000 -0.304 0.000 -0.182 0.000 -0.123 0.000
Mental condition 0.012 0.710 0.092 0.041 0.095 0.024 -0.022 0.653 0.015 0.665 -0.244 0.000
Dementia -0.115 0.004 -0.256 0.000 -0.252 0.000 -0.300 0.000 -0.149 0.000 -0.441 0.000
Hypertension 0.032 0.016 0.055 0.004 0.030 0.099 0.056 0.009 0.009 0.599 0.085 0.000
Ischemia 0.024 0.199 -0.025 0.339 0.052 0.038 0.048 0.114 0.004 0.888 0.039 0.088
Arrhythmia 0.073 0.000 0.028 0.361 0.050 0.076 0.078 0.020 0.022 0.416 -0.055 0.031
Heart failure -0.094 0.000 -0.123 0.000 -0.059 0.018 -0.024 0.404 0.012 0.585 -0.083 0.000
COPD -0.165 0.000 -0.148 0.000 -0.118 0.000 -0.038 0.220 0.084 0.001 0.067 0.005
Skin ulcer -0.069 0.015 -0.032 0.433 -0.055 0.154 -0.162 0.000 -0.062 0.095 -0.089 0.021
Orthopedic (other than PPS) 0.133 0.000 0.154 0.000 0.070 0.001 0.171 0.000 0.106 0.000 0.149 0.000
Incontinence -0.125 0.006 -0.040 0.575 -0.067 0.272 -0.110 0.095 -0.159 0.000 -0.078 0.134
Symptoms, signs, & ill-defined conditions 0.008 0.684 -0.014 0.654 -0.009 0.744 -0.002 0.948 -0.025 0.277 -0.133 0.000
Diagnosis Severity
Number of severity ratings >2 0.036 0.000 0.048 0.000 0.036 0.000 0.034 0.000 0.046 0.000 0.049 0.000
Sensory Status
Partially vision impaired -0.103 0.000 -0.086 0.000 -0.091 0.000 -0.138 0.000 -0.096 0.000 -0.070 0.000
Severely vision impaired -0.440 0.000 -0.442 0.000 -0.423 0.000 -0.332 0.000 -0.450 0.000 -0.518 0.000
Speech: Minimum difficulty -0.022 0.203 0.004 0.864 0.015 0.520 -0.085 0.001 -0.167 0.000 -0.093 0.000
Speech: Moderate difficulty -0.123 0.000 -0.124 0.021 -0.205 0.000 -0.230 0.000 -0.416 0.000 -0.240 0.000
Speech: Severe difficulty -0.403 0.000 -0.387 0.000 -0.676 0.000 -0.593 0.000 -1.004 0.000 -0.687 0.000
Integumentary Status
Surgical wound present 0.269 0.000 0.270 0.000 0.267 0.000 0.457 0.000 0.209 0.000 0.421 0.000
Stage of most problematic pressure ulcer -0.129 0.000 -0.167 0.000 -0.125 0.000 -0.133 0.000 -0.076 0.000 -0.093 0.000
Status of most problematic stasis ulcer -0.084 0.000 -0.073 0.006 -0.085 0.000 -0.070 0.018 -0.004 0.846 0.029 0.225
Functional Status/Physical Functioning
ADL/IADL index -0.232 0.000 -0.258 0.000 -0.184 0.000 -0.214 0.000 -0.070 0.000 -0.094 0.000
Hous: Light tasks only                        
Hous: Intermittent assistance 2.962 0.000                    
Hous: Usually requires assistance 3.273 0.000                    
Hous: Totally dependent 3.558 0.000                    
Laun: Light laundry only                        
Laun: Totally dependent     2.612 0.000                
Shop: Needs some assistance                        
Shop: Only if delivered         2.539 0.000            
Shop: Totally dependent         3.674 0.000            
Lt Meal: Able, but not regularly                        
Lt Meal: Totally dependent             1.108 0.000        
Phon: Able, with adapted phone                        
Phon: Answers, but has trouble calling                 0.283 0.000    
Phon: Sometimes answers/limited conversation                 0.698 0.000    
Phon: Can listen with assistive device                 0.906 0.000    
Phon: Totally dependent                 1.386 0.000    
Oral Med: Able if prepared                        
Oral Med: Totally dependent                     1.260 0.000
Elimination Status
Urinary incontinence during the night -0.007 0.752 -0.091 0.007 -0.027 0.377 -0.046 0.195 -0.087 0.001 -0.060 0.032
Urinary incontinence during the day -0.128 0.002 -0.192 0.003 -0.226 0.000 -0.129 0.040 -0.244 0.000 -0.157 0.001
Urinary incontinence during the night & day -0.141 0.000 -0.212 0.000 -0.166 0.000 -0.172 0.000 -0.170 0.000 -0.151 0.000
Urinary catheter present -0.182 0.000 -0.135 0.005 -0.148 0.001 -0.267 0.000 -0.238 0.000 -0.176 0.000
Bowel incontinent less than weekly -0.065 0.102 0.007 0.910 -0.016 0.772 -0.038 0.522 -0.032 0.373 -0.052 0.254
Bowel incontinent 1-3 times/week -0.208 0.000 -0.059 0.359 -0.104 0.047 -0.112 0.043 -0.165 0.000 -0.212 0.000
Bowel incontinent 4-6 times/week -0.383 0.000 -0.295 0.009 -0.346 0.000 -0.338 0.000 -0.247 0.000 -0.351 0.000
Bowel incontinent daily or more often -0.379 0.000 -0.347 0.000 -0.386 0.000 -0.388 0.000 -0.351 0.000 -0.436 0.000
Ostomy 0.063 0.126 0.065 0.275 0.008 0.887 -0.093 0.167 0.030 0.618 0.045 0.430
Neuro/Emotional/Behavioral Status
Cog Func: Requires prompting -0.011 0.546 -0.022 0.425 -0.047 0.067 -0.059 0.038 -0.100 0.000 -0.189 0.000
Cog Func: Requires assistance & some direction -0.066 0.038 -0.078 0.125 -0.162 0.000 -0.172 0.000 -0.146 0.000 -0.310 0.000
Cog Func: Requires considerable assistance -0.106 0.066 -0.432 0.000 -0.558 0.000 -0.158 0.048 -0.167 0.000 -0.458 0.000
Cog Func: Totally dependent -0.498 0.002 -1.030 0.019 -1.173 0.000 -0.627 0.004 -0.479 0.000 -0.961 0.000
Conf Freq: In new situations 0.003 0.834 -0.020 0.395 -0.029 0.185 -0.127 0.000 -0.063 0.003 -0.193 0.000
Conf Freq: Awakening at night -0.022 0.647 -0.246 0.002 -0.205 0.002 -0.178 0.012 -0.137 0.002 -0.304 0.000
c statistic -0.115 0.000 -0.248 0.000 -0.177 0.000 -0.301 0.000 -0.215 0.000 -0.360 0.000
Conf Freq: Constantly -0.283 0.000 -0.573 0.000 -0.366 0.000 -0.471 0.000 -0.422 0.000 -0.593 0.000
Anx Freq: Less than daily 0.030 0.041 0.059 0.006 0.058 0.004 0.056 0.017 0.046 0.012 0.073 0.000
Anx Freq: Daily but not constantly 0.039 0.030 0.110 0.000 0.061 0.012 0.127 0.000 0.136 0.000 0.165 0.000
Anx Freq: All the time 0.043 0.388 0.121 0.094 0.120