Section C in the OASIS-E Guidance Manual provides instructions for assessing cognitive function through nine key items. Of these, three items—M1700 (Cognitive Functioning), M1710 (When Confused), and M1720 (When Anxious)—are critical for inclusion or exclusion from many OASIS-based outcome quality measures. Accurate assessment of these items plays a significant role in determining quality measure calculations.
M1700: Cognitive Functioning
M1700 assesses the patient’s cognitive functioning on the day of evaluation. This includes alertness, orientation, comprehension, concentration, and immediate memory for simple commands. When answering this item, clinicians should consider the following:
- Cognitive dysfunction observed during the visit.
- Cognitive behavior from the previous 24 hours.
- The level of supervision and care required due to cognitive deficits.
Patients assessed with Response 4 (Totally dependent due to disturbances like constant disorientation, coma, persistent vegetative state, or delirium) will trigger an exclusion from OASIS-based outcome quality measures. This reflects the severity of the cognitive deficits.
M1710: When Confused and M1720: When Anxious
M1710 assesses the specific times or situations when the patient experiences confusion, while M1720 focuses on the frequency of the patient’s anxiety over the last 14 days.
For both M1710 and M1720
- Clinicians should consider what they observe and what is reported by the patient or caregiver over the past 14 days, not just on the day of assessment.
- If a patient is non-responsive (i.e., unable to answer or provide a response that allows a clinical judgment), clinicians should still attempt to gather information from caregivers or medical records to make an informed assessment.
Non-Responsive Patients:
If a patient is non-responsive and no relevant information can be obtained from caregivers or medical records, the clinician should respond “NA.” Coding NA in M1710 or M1720 excludes the episode from OASIS-based outcome quality measures.
Understanding Non-Responsiveness
Non-responsive patients are those who cannot provide answers that allow clinicians to make an informed judgment about their orientation or anxiety levels. This does not include patients who are merely uncooperative or refuse to answer questions.
When a patient meets the criteria for non-responsiveness, agencies must code the items accordingly to avoid erroneous inclusion in quality measures. For instance, a patient in a persistent vegetative state or unresponsive in a way that inhibits clinical judgment would not be expected to improve and should be excluded from the outcome measures.
Avoiding Errors and Missed Opportunities
Agencies should be cautious not to exclude patients from quality measure calculations based on misunderstandings of the guidance or incorrect coding. Inaccurate OASIS assessment can lead to missed opportunities for quality improvement.
Properly assessing cognitive items ensures accurate data collection and optimal agency performance reporting. Since these cognitive items are often overlooked, re-education to ensure a clear understanding of their impact can offer significant benefits in quality measure outcomes.
Accurate assessment and coding of cognitive items—particularly M1700, M1710, and M1720—are essential for quality data collection and reporting. By educating clinicians on OASIS-E guidance, home health agencies can improve their reporting accuracy, better measure performance, and avoid missing opportunities for quality improvements.
