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Contact: Jennifer Felsher
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Email: jfelsher@ahqa.org

New Study Assesses QIO Efforts in Improving Health Care for Millions of Older Americans

Washington , DC – Intensive efforts by the nation’s Quality Improvement Organizations (QIOs), supported by the Medicare program, likely led to nationwide improvements in the quality of health care provided to patients in a wide variety of settings, according to a study released today in the online edition of the Annals of Internal Medicine.

The study, conducted by federal researchers, assessed improvement in care in areas such as diabetes management, appropriate heart failure treatment, and pain management in nursing home residents.

The findings add to a growing body of evidence that demonstrates the effectiveness of QIO efforts and the increasingly important role the national QIO program plays in health care improvement. For most measures, greater improvement was observed in “the providers with which the QIO worked closely,” wrote the authors. “These findings are consistent with an effect of the QIO Program and an effect of QIO technical assistance.”

“Assessment of the Medicare Quality Improvement Organization Program,” (http://www.annals.org) assessed improvements in care using five nursing home quality measures, 11 home health measures, 21 hospital measures, and four physician practice measures.

“This study strongly suggests that the assistance QIOs give to providers is improving care for patients across the country,” said David Schulke, American Health Quality Association (AHQA) Executive Vice President.  “QIO efforts, supporting those of providers, are helping patients get faster and better pneumonia treatment, reducing surgical infections, and improving the quality of life in nursing homes.”

Findings

QIOs worked intensively with a subset of health care providers in physician offices, nursing homes, and home health agencies. These providers achieved greater improvement on 18 of 20 clinical quality measures than providers that did not work intensively with a QIO. Other significant findings:

• Nursing homes working with QIOs improved on all five measures studied – those working intensively with a QIO improved to the greatest degree. For example, QIOs and nursing homes working most closely together halved the number of nursing home residents in chronic pain (from 13% of residents to 6.2%), and halved the percentage of nursing home residents who were restrained (reduced from 16.5% to 8.4%).
• Home health providers working with QIOs improved to a greater extent than providers not working with QIOs on eight of 11 clinical quality measures. Those working most closely with the QIOs improved to a greater extent than other agencies on all 11 measures.
• Physician offices working with QIOs improved in all four measures studied, and improved by greater amounts than offices that did not work with the QIOs. The greatest improvement was seen in the quality of care for patients with diabetes. Timely blood sugar testing improved by about 9% and timely lipid profile testing improved by about 11%.
• QIOs working more intensively with physician practices were able to reverse two apparent trends. These practices increased the number of women receiving timely mammograms and the number of patients with diabetes receiving a key retinal eye exam. Practices not working with their QIO saw decreases in these two measures.
• Hospital care improved in 19 of 21 measures studied. The study could not compare hospitals that worked with QIOs with those who did not because QIOs were asked to help hospital providers throughout their state to improve. However, substantial improvement in surgical infection prevention occurred at a time preceding the adoption of surgical infection measures by the JCAHO and public reporting of hospital performance on these measures.

“The evidence shows that when QIOs and providers work together, the quality of care improves faster.  Much of the credit for these improvements goes to providers who are willing to change and work with QIOs to improve patient care,” said Schulke.  “This study is consistent with our experience in the field. Providers improve faster with the QIOs’ help than when left on their own.” 

The study includes analysis and comparison of data collected as part of the QIO 7 th Scope of Work contract with CMS, which ran from August of 2002 to July of 2005. Researchers compared baseline and remeasurement data for a total of 41 clinical quality measures (20 in nursing homes, home health, and physician office; 21 in hospitals).

Growing Body of Evidence

The findings underscore other recent research showing how QIO assistance helps providers improve care they deliver to Medicare beneficiaries. The 2005 National Healthcare Quality Report, released by the Agency for Healthcare Research and Quality earlier this year, found that QIO measures for heart disease and pneumonia showed a combined rate of improvement that was almost four times higher than all other non-QIO measures. The American Journal of Surgery last year published a report on a national QIO project involving 43 hospitals that reduced their post-surgical infection rate by 27% with QIO assistance. In a baseline survey of stakeholders working with QIOs in health care improvement released by CMS in May 2006, three out of four stakeholders agreed that “providers are providing better care because of QIOs.”

In July, Representative Michael Burgess (R-TX) introduced legislation (HR 5866) in the U.S. House of Representatives to accelerate improvement in the quality of health care by modernizing and strengthening the QIO program, including a scientific evaluation to measure the effect of the Medicare QIO program.

QIOs are community-based organizations that employ health care quality improvement experts, physicians, nurses, pharmacists, health IT specialists, and diverse support staff that work under contract to the Centers for Medicare & Medicaid Services to improve care for the nation’s 42 million Medicare beneficiaries. QIOs are working in all 50 states, the District of Columbia , and two U.S. territories. The program is efficient—while it is the largest coordinated federal investment in health care quality, its funding amounts to less than one tenth of one percent of all Medicare spending.

AHQA is dedicated to improving the safety and effectiveness of health care. AHQA represents the national network of QIOs that work with hospitals, medical practices, long-term care facilities, home health agencies, health plans, pharmacists, and employers to encourage the spread of best clinical practices and improve systems of care delivery. Find your local QIO at: www.ahqa.org