Date of Graduation

Summer 9-6-2016

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


The aim of this CNL Internship Project is to improve the admission and discharge assessments of a home care agency in order to boost agency’s star ratings. The project is being carried out within a home care agency in Northern California. The multidisciplinary team provides services in the patients’ place of residence, an ever-changing setting. The project follows a train-the trainer approach beginning with self-paced learning of the OASIS format. The trainee will conduct an admission, also known as start of care (SOC), assessment followed by trainer critique and advisement. Establishing a rapport early will aid the assessment process. Face-to-face assessment follows a review of systems that includes both interview and observation. This project has experienced many stopgaps due to scheduling constraints. An unexpected challenge has been the reluctance of staff to participate. This project is ongoing therefore no results are available to evaluate at this time. Given the many moving parts related to the star rating it will likely be at least a year before they reflect this projects’ efforts. As an application in healthcare reform the OASIS is still relatively new. Research on its overall impact on the delivery of care is limited. CMS representatives state the implications star rating may have for future reimbursement and encourage OASIS training, however no evidence-based practice can be found on how home care agencies can best approach OASIS and its anticipated revisions.

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