Purpose: We focused on client outcomes in home care, and identified influential care items, achievement of care implementation and care processes in outcome improvement. Methods: (1) We aimed to refine 119 care items for 23 client outcome areas in home care. The number of visiting nursing stations were calculated by types of organizations across the country in October 2000, and based each on the proportional distribution ratio. We asked the directors of 500 stations for their participation in this survey, and received 220 replies. We refined the number of care items to 60 for statistical analysis. (2) We carried out the survey on these 60 care items for 527 clients, who were 40 or over and continued: to receive care services for two months, of 7 visiting nursing stations in November 2000. Terminal cases were excluded., Achievement of home care was weighted by : it was "always," "sometimes," and "not" implemented when necessary. (3) Client outcomes were measured at two points, September and November, 2000. We measured Changes using 41 assessment items in 23 outcome areas of health conditions including ADL, IADL and symptoms during a period of two months. (4) We classified the cases into improvement and non-improvement groups in outcomes. It was compared with the achievement degrees of each care item using t-test, and we studied the care items influencing the improvement of outcomes, and the degrees of implementation. Results: In 23 outcome areas for care effectiveness, there was a significantly higher, achievement degree of care in 13 areas in the improvement group over those in the non-improvement group. The more cases that "it was always implemented when it was necessary," the more their outcomes were improved. The areas likely to improve outcomes of clients were: (1)JABC independence and locomotion in ADL, (2)meal preparation, safety of key, fire and water, management of air conditioning and heater in IADL, and urinary incontinence. The outcome areas of caregivers were : (1)physical fatigue, (2)psychological fatigue, (3)the knowledge and technique of caregiving, (4)free time for caregivers, and (5)willingness to continue caregiving. The care items that influenced many of the outcomes were encouragement, securing water, urinary incontinence, medication and sleep. When looking at the care processes in care items, of assessment, planning, care implementation and care evaluation/record, many items in care evaluation/record were significantly higher in the improvement group than, in the non-improvement group. Evaluation and record were identified as an important factor for outcome, improvements. Conclusion: This study found that client outcomes were more improved when there were more cases that "it is always implemented if it is necessary," and care evaluation was especially effective in the reprocess.