Chapter 5 – Changes to OASIS E-1 Documentation

There are changes to OASIS and how they may affect agencies and clinicians. Changes start after January 1, 2023. This section discusses validity, generalizability, and reliability. We discuss each of these aspects in more detail.

Changes to OASIS

The OASIS-E instrument is the next step in the implementation process. It will capture data for several measures, including the Transfer of Health Information to Provider-PAC and Standardized Patient Assessment Data Elements. The changes were delayed to ensure maximum flexibility for providers. They are effective January 1, 2021, and will be finalized with the Office of Management and Budget. If you are planning to implement this new instrument, you should familiarize yourself with the new structure before implementing it.

As of January 1, 2019, OASIS-E is undergoing change, including changes in the guidance and a few new items. You should start preparing early to ensure that you are prepared for this important change. A thorough OASIS training will focus on the changes. The Ultimate OASIS-E virtual training will take you through all items. You can also get the guidance and support you need to complete the new form as early as 2023.

A composite change methodology places all OASIS items on the same playing field. For example, the ambulation question contains six levels of change. For example, starting from six means your patient is not ambulatory, and improving to zero will result in improvement of six levels. There are no such levels for other OASIS items. It is important to note that the OASIS was designed with the ambulation question in mind.

In addition to the modifications to the OASIS, the newest version includes an evidence-based screening tool, the PHQ-2. While this tool is embedded in the OASIS, it is not mandatory. This means home health clinicians can use other tools to assess patients for depression. Although these changes are expected to improve the reliability of the questionnaire, further studies are necessary to determine the impact of the OASIS on clinical outcomes.

While implementing the new OASIS-E is relatively simple, there is a steep learning curve to get through. It is not the typical “train the trainer” scenario; instead, the process will involve a whole agency’s staff. Once it is official, everyone should take the time to get up to speed on the new items. Home health agencies should make a plan for learning new items and implementing the changes.

Reliability

Despite recent developments in medical care, there is still considerable uncertainty regarding OASIS reliability and validity. Studies have shown low reliability and validity for some OASIS items, raising questions about their usefulness in outcome measurement. In particular, these findings highlight the unidimensional nature of the OASIS’s functional, behavioral, and affect domains. The use of response categories for functional items may be problematic, and combining scores for different disability domains may not be valid.

The lack of standardized testing and a limited number of studies demonstrates that OASIS cannot be used for longitudinal research. Additionally, the limited number of studies available for the various OASIS versions does not allow researchers to establish the validity and reliability of individual items and composite scores. Researchers must therefore exercise caution when using OASIS data to investigate differences in outcome, contributing factors, and disparities. For this reason, future studies should address the issue of OASIS reliability and validity.

OASIS was not designed to be a comprehensive assessment tool. It is used in three phases: at the beginning of care, at 60-day follow-ups, and at discharge. Because of the limited number of items, home health agencies will likely need to supplement OASIS items with other assessment tools. Moreover, OASIS does not measure vital signs, which are an important aspect of patient care.

A systematic literature review of OASIS data has revealed that there is a lack of consensus on the validity and reliability of OASIS. While there is no uniform standard, most studies report a wide range of results. However, some studies failed to address other important issues, including the reliability of OASIS scores. One study even found that OASIS scores were higher for home health care agencies than for other health care settings.

Validity

The validity of OASIS items varies from study to study. In general, they have high validity rates, with Cronbach’s alpha of.87 or higher. However, there are several factors that can influence OASIS item by item validity. Moreover, patients who use OASIS items may have a variety of different needs. As such, additional studies are necessary to confirm these results. In any case, validating OASIS with an item-by-item system is highly recommended.

The OASIS is valid for the ADLs and cognitive status appraisal, but may not be sensitive enough for the IADLs and depressive symptoms. The IADLs represent a persistent challenge, and the items that measure those challenges are important for the assessment of depression. However, it is important to follow the recommendations for this assessment in case of severe depression. This study was supported by the National Institute of Nursing Research, grant number NR005081.

The study was part of a larger study that examined factors associated with health outcomes in Medicare home health care patients. Twenty-eight Ohio Medicare-certified home health agencies participated in the study. During these visits, these RNs attempted to interview consented patients. A systematic review of the existing studies found 12 articles on OASIS item by item validity. This research was limited by the nonrepresentative nature of the sample.

The OASIS data interchange protocol is the standard for the exchange of health care data. It has become a standard across the U.S. healthcare system. The OASIS protocol was designed by the National Institute of Health (NIH) to make sure that health care providers are compliant with federal and state guidelines. OASIS-D1 is the latest version. It includes information about the requirements and standards of the system.

Generalizability

There are some important issues regarding the generalizability of OASIS item-by-item scores. The items tested, statistical procedures, and methods used in the OASIS have not been consistently applied throughout the years. There are also several differences in coding instructions. The results are only tentative and additional studies are needed to confirm them. The OASIS is a valuable tool in assessing patient outcomes, research, and quality improvement.

The OASIS stimulus set contains 900 open-access images normed on two affective dimensions. This database contains two distinct affective dimensions: valence and arousal. Both are measures of the positivity or negativity of an image. The valence scale contains three meaningful anchor points that can be used to generalize the results. Compared to other visual stimuli, the OASIS image sets are the most generalizable.

While studies have generally produced similar results, their interpretations of the findings may differ. Expert reviews are needed to develop standards for acceptable levels of reliability and validity. Such standards can be used to refine OASIS over time. Unfortunately, the studies do not examine the accuracy of OASIS completion and the training of staff in home health agencies. Several differences were found between therapy and nursing. These findings should be a cause for concern for future studies.

It is important to note that the OASIS does not have a large number of studies. A multistage probability sampling design would be more useful for validating individual OASIS items, although this approach would not necessarily improve point estimates. Although the study participants’ experience was highly diverse, OASIS items demonstrated strong correlations with anxiety measures, including behavioral and clinician-rated anxiety severity. However, further studies need to evaluate the convergence of OASIS scores with these outcome measures.

Although OASIS is used extensively in clinical practice, very few studies have examined the psychometric properties of the scale. It should be tested within the context of home healthcare, where variables such as productivity, case management, and agency incentives may have an impact on the score. Likewise, studies should consider the generalizability of OASIS item by item scores compared to the CMS 485.