Study Documents Progress in QIO Hospital Work

A study published March 21, 2005 in the bi-monthly journal Health Services Research presents a positive assessment of Quality Improvement Organization (QIO) work to improve care in hospitals.

Researchers conducted interviews with 100 directors of quality management from a randomly selected cross-section of all acute care hospitals operating in 2001. More than ninety percent of the hospitals reported that QIOs had initiated specific interventions, most commonly providing educational materials, benchmark data, and hospital performance data. The majority of respondents, sixty percent, rated QIO interventions as “helpful” or “very helpful.”

The study was led by Dr. Elizabeth H. Bradley, an associate professor at the Department of Epidemiology and Public Health at the Yale School of Medicine. Based on interviews conducted in 2002, the study finds that QIOs have largely overcome “the previously adversarial and punitive roles” of their predecessors, the Peer Review Organizations.

“The generally positive view among most hospital quality improvement directors concerning the QIO interventions suggests that QIOs are potentially poised to take a leading role in promoting quality of care,” the authors say. They recommend that QIOs, “find ways to integrate physicians and hospital senior management more fully into QIO quality improvement initiatives.”

“This study is a strong endorsement of the relationships QIOs had established in 2002, when the most common QIO strategy involved working with designated quality staff in hospitals,” said David Schulke, executive vice president of the American Health Quality Association, which represents the national network of QIOs.

“In the three years since the study survey was conducted, QIOs have increasingly engaged physicians and hospital executives in the quality improvement process, just as the authors of this study have advised. Over the next three years, all QIOs will be working with hospital leaders because we’ve learned the importance of recruiting executive and board support for the clinical improvement activities of front line caregivers,” Schulke said.

Since 2002 most QIOs have also conducted intensive “collaboratives” that bring together teams of hospital staff to prevent surgical infections, and improve care for chronic conditions such as diabetes. Beginning in the fall of 2002, CMS contracted with QIOs to help nursing homes and home health agencies measure and improve the quality of their services.

Independent surveys conducted nationwide in 2004 show that almost all providers who worked closely with QIOs said they were satisfied with QIO services. The level of satisfaction ranged from a high of 95% among home health agencies to almost 90% of physician offices:

Home Health Agencies: 95%
Hospitals: 92%
Managed Care Organizations: 94%
Nursing Homes: 93%
Physician Offices: 89%

Jonathan Sugarman, MD, MPH , President of AHQA notes that, “This study is consistent with a growing body of data demonstrating the effectiveness and acceptability of QIOs in improving health care. The high level of satisfaction with QIOs among hospital quality management directors is consistent with high satisfaction scores among hospital, nursing home, and home health agency staff and practicing physicians in independent surveys commissioned by CMS .”

“It is very encouraging that hospital staff acknowledged the impact that QIOs have on quality of care. It can be difficult to attribute causation to improvements associated with QIO work, but it is highly unlikely that hospital quality managers would mistakenly attribute improvements in care to the work of external consultants like QIOs. In addition, the opportunities for improvement identified by hospital staff are consistent with the views of QIO leaders,” said Sugarman.

For more information about the work of QIOs in hospitals: www.ahqa.org

To review the article,“From Adversary to Partner: Have QIOs Made the Transition,” contact journalnews@bos.blackwellpublishing.net

The American Health Quality Association is dedicated to improving the safety and effectiveness of health care. AHQA represents the national network of Quality Improvement Organizations (QIOs) that work with hospitals, medical practices, health plans, long-term care facilities, home health agencies, and employers to encourage the spread of best clinical practices and improve systems of care delivery.