EMBARGOED FOR RELEASE: 1PM ET
May 22, 2006
Contact: Richard Deutsch
Phone: 202-261-7573
Website: www.ahqa.org

• QIOs Target Disparities in Health Care

Report Shows QIOs Reducing Disparities in
Quality of Care

Washington, DC – A new report shows Quality Improvement Organizations (QIOs) making significant progress reducing disparities, or variations, in the quality of health care received by underserved groups—principally African-Americans, Hispanics, Native Americans, and rural residents. Noting the positive results of QIO initiatives, the report calls on Medicare to launch a coordinated national campaign to address health care disparities.

The report, “QIO Efforts to Reduce Healthcare Disparities, 2002-2005”, was released today at a Capitol Hill briefing by the American Health Quality Association (AHQA) which represents the national network of QIOs. The report was prepared by QSource, the Tennessee QIO, which has a Medicare contract to support QIO work with the underserved.

In what it calls a “substantial finding,” the report notes that interventions used by QIOs in 27 of 45 states (60%) facilitated greater improvement on quality measures than demonstrated in a national control group.

QIOs work under contract to Medicare to improve care in hospitals, physician offices, nursing homes and home health agencies. In addition, QIOs conduct initiatives in every state to reduce disparities of care. These initiatives generally target a specific group of underserved Americans and focus on promoting improvement on clinical measures that reflect quality of care for specific diseases or conditions.

For example, during the 2002-2005 contract period, QIOs targeted care provided to African Americans in 22 states and care for rural Americans in 19 states, while QIOs in 12 states or US territories worked with a range of other underserved groups, such as Hispanic Americans and Asian-Pacific Islanders. QIOs worked to reduce disparities in care for diabetes in 23 states and breast cancer in 9 states, with the rest working on heart failure, adult immunization, pneumonia, heart attacks, and surgical infection prevention.

QIOs Effective at Reducing Health Disparities

The report states unequivocally that, “QIO efforts to reduce disparities continue to demonstrate positive results.” Reviewing Medicare claims data during the contract period, the report finds that:

• Forty-nine of 52 (94%) QIO states and territories conducting initiatives for the underserved demonstrated an absolute improvement on quality measures in the targeted underserved population.
• Forty-six of 52 (89%) states and territories demonstrated a reduction in disparities, defined as greater improvement in underserved populations compared to white or urban groups.
• In the 23 states where QIOs focused on reducing disparities in diabetes care, there was a median absolute improvement of 12.6 percentage points for the selected diabetes measures, representing a 33% relative improvement over baseline. This reduction in disparity, the report says, “Clearly demonstrates QIO effectiveness at improving diabetes indicator rates among the underserved.”
• In the 22 states or territories where QIOs worked to improve care for African Americans, there was a median absolute improvement of 7.5 percentage points, representing a 26% relative improvement over baseline.
• Overall, health care disparities were reduced from 13.6% to 8.5%.

Effectiveness of QIO Interventions

The report also looked at the effectiveness of specific QIO interventions, or strategies, that were used to generate improvements in care. These strategies often involve working with physicians and health care facilities to examine and change organizational and clinical aspects of patient care processes so that underserved beneficiaries receive appropriate care for their condition. QIOs also partner with community and faith-based groups, service providers, and facilities to educate beneficiaries directly about the importance of preventive services, breast cancer screening and diabetes management. When these partnerships are integrated with strategies directed at physicians, they achieve even greater results.

Medicare Should Boost Spending to Reduce Disparities

Noting that only 3.4% of the QIO program funding goes towards reducing disparities, the report calls on Medicare to increase QIO funding for this important work. It also calls on Medicare to “design and launch a national campaign to address healthcare disparities.”

Specific recommendations in the report include:

• Extending QIO efforts to address disparities that exist in other care settings such as nursing homes and home health agencies, and address disparities in the continuity of care across health care settings.
• Expanding QIO efforts to address disparities under the new Medicare prescription drug benefit, such as disparities in drug adherence rates among underserved beneficiaries with chronic conditions.
• Considering ways that Medicare and Medicaid data might be combined to define new opportunities to address disparities within the dually enrolled population. The linking of these key data sources should be a priority for new disparities reduction activities.