QIOs Begin Training Home Health Service Providers Nationwide
Providers, Consumers Back Effort To Improve Care

Washington, D.C.— Quality Improvement Organizations (QIOs) have begun training Medicare-certified home health agencies across the nation in the use of an innovative and effective method for continuously improving care. The voluntary QIO training program—funded by the Centers for Medicare and Medicaid Services (CMS)—is provided at no cost to the agencies.

The QIO program complements a CMS initiative to publicly report on quality of care provided by individual home health agencies that begins on May 1 in Florida, Massachusetts, Missouri, New Mexico, Oregon, South Carolina, West Virginia, and Wisconsin. Nationwide reporting on home health care quality is scheduled to begin in late 2003.

The reporting will provide the public with a picture of how each agency is helping patients improve in areas such as walking, bathing, toileting, and taking medication, as well how agencies are helping patients cope with pain and confusion. Home health care typically involves skilled nursing services, home health aide services, therapy, medical social services, and certain medical supplies and equipment.

QIOs are private organizations that work under contract to CMS to improve the quality of care in the nation’s hospitals, doctor’s offices, and nursing homes—and, now, in home health agencies. QIO training shows home health agency staff how to target treatment processes for improvement; how to develop and implement step-by-step plans of action to improve care; and how to integrate continuous quality improvement into day-to-day agency operations. The process—known as Outcome-Based Quality Improvement (OBQI)—involves collection, analysis, and feedback of information on quality of care and patient progress that is of practical value to clinicians.

"Public reporting on quality of care is a motivating force for many agencies to work with QIOs," said David Schulke, executive vice president of the American Health Quality Association, which represents the national network of Quality Improvement Organizations. "QIO training gives staff the tools to quickly make a difference, which is good for staff morale and good for the patient."

Initiative Gains Approval Of Providers, Consumers

QIO training, coupled with the CMS initiative to provide information on quality of care, is receiving broad support from national organizations representing the home health care industry, such as the National Association for Home Care and Hospice, the Visiting Nurse Associations of America, the American Association of Homecare, and the American Association of Homes & Services for the Aging (AAHSA.)

"The new home health quality initiative will help home health providers maintain and continuously improve the quality of their services. The initiative will also help consumers identify quality home health," notes William Minnix, CEO of AAHSA. "We pledge our support in working with all parties to make the phased-in program and the eventual national rollout a success."

The initiative has also been endorsed by major consumer groups such as AARP and the Consumer Coalition for Quality Health Care, a Washington coalition of over 50 seniors groups concerned about quality of health care in America.

Many participating providers in states where the public reporting of information on quality of home health care will begin next week are also enthusiastic.

"We are very excited to have this opportunity for evaluation and continued improvement. We have not had this opportunity before," said Linda Bodien, Director of Clinical Services for Ministry Home Care in Marshfield, Wisconsin. "Our whole industry has been asking for this feedback and the ability to benchmark ourselves against others."

"The information we are getting from the training is practical and applicable to improving patient care. The project we chose to work on first is oral medication administration, which has a direct applicability to helping patients become more independent," noted Mary Ashmore, RN, Quality Management/Staff Development Coordinator at St. Francis HomeCare in Greenville, South Carolina. "It all adds up to a better product and better care for the patient."

Test Shows Power of QIO Training

Before launching the current program to train home health agencies, QIOs tested OBQI training in 2001-2002 with the cooperation of 400 home health agencies in Maryland, Michigan, New York, Rhode Island, and Virginia. More than 90% of the agencies that signed up completed the training, with participating agencies improving targeted measures of patient care by an average of seven percentage points in one year. Measures not selected for training showed little or no improvement. Results achieved by a number of individual agencies were dramatic. For example:

• With assistance from the Delmarva Foundation, the Maryland QIO, Personal Touch Home Care (MD) implemented an OBQI program that reduced emergency hospital admissions for patients with congestive heart failure during 2001 from 50% to 17%.
• With support from Quality Partners of Rhode Island, the Rhode Island QIO, the Cathleen Naughton Home Health Agency in Rhode Island used OBQI to establish and monitor patient exercise programs that doubled the percentage of patients in 2001 who improved ambulation/locomotion from 12% to 25%.
• The Visiting Nurse Association of Staten Island, with assistance from IPRO, the New York QIO, helped 72.9% of patients improve the status of their surgical wounds in 2001, compared to 66.4% previously.
• Home Care Connections, Inc., serving mostly rural patients in the vicinity of Richmond, VA, helped improve measures of patients’ mobility from 52.8% to 57.1% in 2002, nearly 17 percentage points above the national average.

Positive reports from participants make it likely that final results for 2002 will show continued progress, according to staff at the Delmarva Foundation, the lead QIO for the test project. "What surprised us was how eager the agencies were to work with QIOs," says Delmarva’s Julie Crocker, director of the project. "The agencies saw a real opportunity to improve patient care, because this training offers such a well-structured way to plan and focus on improving treatment."

FOR MORE INFORMATION: www.ahqa.org/briefing