OT Home Health Evaluation Checklist & Quality Measures: Occupational Profile

OT Home Health
Evaluation Checklist &

Quality Measures
This checklist is not comprehensive and does not replace the clinical judgment of an occupational therapist. The checklist should
be used as a reminder of baseline areas that should be addressed during the OT evaluation process. The areas below relate to
occupation-based practice and quality performance measures.
Use the checklist below during the evaluation as a reminder of key clinical areas to address. AOTA encourages practitioners to print
off the checklist and bring it with you to help guide client evaluations, as well as to educate and train your colleagues regarding the
occupational therapy evaluative process. The checklist supports high quality OT evaluations that lead to occupation-based, client-
centered interventions.
A comprehensive occupational therapy evaluation is based on a theoretical model and follows the Occupational Therapy Practice
Framework. A top-down approach identifies occupations that are challenging and important to the client and then assesses related
performance skills, client factors, environments and context, and performance patterns.
For more information on the Medicare Patient Driven Groupings Model (PDGM), this checklist, and the important role of
occupational therapy click on Home Health at www.aota.org/value.
Occupational Profile:
Download the template at www.aota.org/profile.
Client’s Concerns
Successful occupations
Interests & Values
Occupational History
Performance Patterns
Habits  Routines  Roles  Rituals
Environment: Supports & Barriers (Physical, Social)
Context: Supports & Barriers (Cultural, Personal, Temporal, Virtual)
Client’s Priorities and Desired Outcomes
Analysis of Occupational Performance

Click on the Quality Toolkit at www.aota.org/value for links to standardized assessments and screeners used in each of the
areas below.
Addressed Is this area a Priority Addressed Is this area a Priority

Occupations
ADLs   IADLs  
Performance Skills
Psychosocial/Behavior Skills   Fall Prevention/Fear of Falling  
Client Factors—In addition to areas identified while addressing ADLs and IADLs (e.g., motor, sensation, pain)
Vision   Functional Cognition  
Performance Patterns
Habits, Routines, Roles  
Contexts & Environments  
Include Safety Screen
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Home Health Quality Measures (2020)
Download details and read more about the Value Based Payment and Quality Reporting Programs in HH at www.aota.org/value.
Agencies are scored based on the measures below. Talk to your administration/team to identify your agency’s current scores and
which measures are priorities for your team. How does your practice contribute to your facility scores on priority measures?
Quality Reporting Program

Measure Our Score as of ______ (date) Notes
Percentage of home health quality episodes during which patients improved or stayed the same
in ability to groom self.
Percentage of home health quality episodes during which patients improved in ability to dress
upper body.
Percentage of home health quality episodes during which patients improved in ability to dress
lower body.
Percentage of home health quality episodes during which the patient got better at bathing self.
Percentage of home health quality episodes during which the patient improved or stayed the
same in the ability to bathe.
Percentage of home health quality episodes during which patients improved in ability to get to
and from and on and off the toilet.
in ability to get to and from and on and off the toilet.
in ability to manage toileting hygiene.
Percentage of home health quality episodes during which the patient improved in ability to get
in and out of bed.
Percentage of quality episodes in which the patient has one or more Stage 2–4 pressure ulcers,
or an unstageable ulcer/injury, present at discharge that is new or worse since the beginning of
the quality episode.
Percentage of quality episodes in which the patient experiences one or more falls with major
injury.
Percentage of home health stays in which patients were admitted to an acute care hospital
during the 60 days following the start of the home health stay.
Percentage of home health quality episodes in which patients were screened for depression
(using a standardized depression screening tool) at start/resumption of care.
Percentage of home health quality episodes in which patients had a multi-factor fall risk
assessment at start/resumption of care.
Percentage of home health quality episodes in which diabetic foot care and patient/caregiver
education were included in the physician ordered plan of care and implemented (at the time of
or at any time since the most recent SOC/ROC assessment).
www.aota.org
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OT Home Health

Evaluation Checklist &

Analysis of Occupational Performance

Addressed Is this area a Priority Addressed Is this area a Priority

Rate this resource and provide feedback at surveys.aota.org/s3/checklist

Quality Reporting Program

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