Qualis Health – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Idaho and Washington – is working to improve quality reporting for clinicians, including those at physician practices and at larger health care facilities.

Critical Access Hospitals in Idaho

In December 2015, the Idaho Bureau of Rural Health conducted a collaborative needs assessment among Critical Access Hospitals (CAHs) that provided insight into their past reporting experiences, challenges and educational needs related to the Physician Quality Reporting System (PQRS), a precursor to the Medicare Access and CHIP Reauthorization Act (MACRA).

“CAHs are community hospitals that have close relationships with their local clinical providers,” says Qualis Health Idaho State Director Linda Rowe. “They have limited resources, so we approached our network of CAHs differently than other hospitals and focused on their unique areas of importance.”

Qualis Health used the information from the Bureau of Rural Health to develop a comprehensive education plan for 10 CAHs that has resulted in approximately 700 providers avoiding nearly $275,000 in penalties and a 43 percent relative improvement in participation of reporting 2016 PQRS data.

As part of its strategy, the QIN-QIO developed educational materials, held community lunch-and-learns at local hospitals across the state, and hosted webinars on aligning physician efforts between PQRS and other clinical goals like Medicare Beneficiary Quality Improvement Project measures and other incentive programs.

‍Qualis Health also developed the MIPS Minute, a 12-part video podcast series with more than 2,200 views as of December 2016, to help facilities and physicians understand the basics as the Quality Payment Program launches in 2017.‍

“Understanding the complexities of MACRA will be essential for physicians and practice staff that care for Medicare patients. The MIPS Minutes videos are an excellent vehicle for building that knowledge base,” a representative of the Washington State Medical Association says.

The QIN-QIO plans to release an updated MIPS Minute series on the final MACRA rules in early 2017.

Idaho is a primarily rural state, which in-and-of-itself can provide unique challenges. The QIN-QIO used a small team approach and leveraged the role of hospitals and providers, many of which are on their own, to foster team support in rural communities. “It takes a team to make quality reporting happen,” says Qualis Health’s Idaho Quality Improvement Consultant Deanna Graham.

The QIN-QIO also worked with key health care stakeholders such as the Idaho Hospital Association and the Idaho Medical Association to share these resources with a broader physician audience.

“As conveners and collaborators, we are thankful that the relationships we have developed in Idaho are moving the needle on quality improvement. We’ve seen many more organizations and providers who now have experience in quality reporting that will be the foundation for their success with the new Quality Payment Program under MACRA,” Graham concludes.

Ambulatory Surgery Centers in Washington

In Washington in 2016, Qualis Health concentrated on ambulatory surgery centers (ASCs), which account for more than 60 percent of all surgical procedures performed in the United States. The QIN-QIO focused on infection prevention – a topic of great interest to ASCs – to engage them in how to use their data for quality improvement purposes and prepare them for pay-for-performance.

Unlike in hospitals, rates of surgical site infections (SSIs) in ASCs are not well known for a variety of reasons, including lack of standard infection definitions for most procedures performed, limited reporting of infections, and inconsistent coding for health care-associated infections in claims data.

However, preliminary analysis of ASC Medicare claims data for Washington shows a rate of 2.85 post-operative infections per 1,000 procedures, which, while low compared to hospital rates, represents a substantial number of adverse outcomes in aggregate, given the high volume of procedures performed in these settings.

‍To engage ASCs and support them in the transition from pay-for-reporting to pay-for-performance, Qualis Health provided half-day infection prevention trainings for approximately 40 ASCs, as well as on-site walkthroughs where possible. The four- to five-hour workshops were interactive and included detailed technical advice relating to care of environment, sequencing of processes, risk assessments and high-level disinfection and cleaning. They also received intensive training on how to use data for quality improvement.

“It’s important for facilities to have scientific tools to gather data they can demonstrate to surveyors and other stakeholders,” says Qualis Health Quality Improvement Consultant Jeff West. “Our focus was on engaging these types of providers on motivating infection control and accurate reporting.”

One day when the clinic was closed to surgery, Qualis Health provided an on-site walkthrough where the entire nursing, technical and administrative staff followed the typical path of patient flow, starting with the waiting room and moving through pre-op, operating room and post-op care.

“ASCs are known for being physician-owned and run with hierarchical structure, thus, we also focused on building communication between various levels of staff with checklists, culture change tools and anything that improves teamwork,” West said.

In 2017, Qualis Health plans to focus on expanding SSI control training with a long series of webinars that repurpose materials and include expert guest speakers as well as QIN-QIO staff.

This story is one of 15 that were included in the 2016 QIO Program Progress Report.

Over the course of a year, the nation’s 15,600 nursing homes provide services to more than three million Americans. To ensure every nursing home resident receives the highest quality of care, Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) and their partners participate in the National Nursing Home Quality Improvement Campaign. As part of the Campaign, QIN-QIOs help nursing homes improve their performance on 13 National Quality Foundation-endorsed quality measures.

In Pennsylvania, home to more than 700 nursing homes, Quality Insights – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Delaware, Louisiana, New Jersey, Pennsylvania and West Virginia – is piloting state-based Affinity Groups to provide technical assistance and peer learning around select quality measures. Beginning in August 2016, Quality Insights led two small Affinity Groups of nursing homes to concentrate on improving bladder and bowel incontinence. Using the Quality Assurance and Performance Improvement (QAPI) process as a framework, nursing home staff met virtually every other week using GoToMeeting for intensive sessions focused on forming process improvement teams, completing Root Cause Analyses, conducting Plan-Do-Study-Act cycles, goal setting and ongoing monitoring of the measures, and sustainability. During off weeks, nursing home teams worked together to complete homework assignments to prepare them for the following week’s session. Nursing homes also learned how they can meet residents’ needs by engaging residents and their families in all nursing home quality improvement activities. At the end of the 12-week program, the Affinity Groups celebrated their accomplishments, and nursing homes received certificates of completion.

Preliminary data show nursing homes participating in the Affinity Groups are seeing improvement on their bladder and bowel incontinence measure, according to the nursing homes’ own data tracking. Nursing homes also indicate they are adopting the best practices, tools and resources they received through their participation in the Affinity Group. In 2017, Quality Insights plans to introduce a QAPI Affinity Group for nursing homes that are just getting started with quality improvement, as well as Affinity Groups concentrating on reducing falls and the unnecessary use of antipsychotic medications.

This story is one of 15 that were included in the 2016 QIO Program Progress Report.

Adverse Drug Events (ADEs) are defined as any harm to a patient resulting from the use of a medication – whether the harms stem from medication errors, overdoses, or adverse drug reactions or interactions. ADEs negatively impact patient health in many ways and potentially cause unnecessary hospitalization or death. Yet despite the serious nature of ADEs, the good news is that most are preventable.

With this in mind, Telligen – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Colorado, Illinois and Iowa – initiated a medication reconciliation project for members of its medication safety care collaborative in response to their feedback, which indicated that “medication reconciliation and communicating about patients’ medication lists” are some of their biggest challenges involving medication safety for their patients.

Medication reconciliation is a review of all the medications a patient takes, including doses and frequency of use. “Medication reconciliation should happen at every juncture in the [care] continuum,” says Katy Brown, Program Manager Lead and Clinical Pharmacy Specialist at Telligen. “Not just once, not just twice, but every time the patient interacts with a provider. Every time a med is changed, and every change in level of care demands an accurate list,” says Brown. Doing so significantly reduces the risk of ADEs and unnecessary hospitalizations, she says.

Telligen’s three-part project aimed to reduce ADEs by increasing the frequency of medication reconciliation in a variety of care settings, including hospitals, clinics and community pharmacies. The first part of the project involved gathering general medication reconciliation process data from care facilities. Telligen created a short online assessment that evaluated care facilities’ current medication reconciliation process against best practices. The QIN-QIO then analyzed the collected data and assigned points to each step of the facility’s medication reconciliation process to create an overall score. Using this data, a Telligen pharmacist gave feedback to providers to help them improve their processes.

‍One important recommendation was granting community pharmacists access to discharge medication lists, as these health care providers typically have extensive contact with patients post-discharge. Initially care providers were reluctant to share their medication lists. Providers cited patient confidentiality and legal concerns, time constraints, problems with faxing and more. However, Telligen provided reassurance that medication lists were shared with virtually all other stakeholders in the care continuum, including home health agencies, nursing homes, primary care providers and specialists, among others. In the end, the providers who chose to participate in Telligen’s project saw immediate benefits in communication between patients and caregivers, as well as lower rates of ADEs through this more holistic care approach.

The project was developed and tested during the summer of 2015, implemented in the fall of 2015 and completed in June of 2016. At completion, 15 communities in Iowa and Colorado had used the assessment tool, and approximately 1,350 patient records had been analyzed. Each “community” is a care collaborative comprised of health care providers and social service agencies. Thus far, the project has helped prevent more than 440 potential ADEs.

This story is one of 15 that were included in the 2016 QIO Program Progress Report. 

The Atlantic Quality Innovation Network (AQIN) – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving New York, South Carolina and the District of Columbia – has committed to changing the way South Carolinians think about immunizations.

Seeking to build on its ongoing vaccination efforts, AQIN, in partnership with the South Carolina Department of Health and Environmental Control (DHEC), launched a coalition in early 2015 of nearly 40 organizations in the state, including the South Carolina Office of Rural Health, the South Carolina Academy of Family Physicians, the South Carolina Pharmacy Association, and the Medical University of South Carolina. Now the coalition has started reaching its goals of sharing best practices, tools and resources in an effort to increase immunizations, and to encourage providers to document and report immunization rates.‍

“We knew from the start that community outreach would be the key to success, so we incorporated immunizations into our other quality improvement work and engaged partners that helped attract new collaborators,” said Melinda Postal, Quality Specialist at AQIN-South Carolina. “That led us to our initial work with the Governor’s Office.”

With encouragement from AQIN, former South Carolina Governor Nikki Haley issued a proclamation that recognized Senior Vaccination Season and the need for expanded vaccination awareness efforts across the state. According to Postal, this recognition was an important tool that helped draw attention to the coalition’s work.

The partnership developed educational bookmarks that have now been distributed to approximately 15,000 seniors and nearly 200 public libraries statewide. One side of the bookmark focuses on flu prevention and the other side on shingles, which also impacts seniors at alarming rates. Coalition members also started a vaccine-awareness monthly newsletter that is disseminated to stakeholders across the state. It aims to encourage providers to prioritize vaccinations, implement best practices and collaborate with peers.

The coalition’s efforts yielded dramatic results during the 2015 flu season, and early numbers for the 2016 season are expected to be equally impactful. From August 2014 to March 2015, 29 out of the 40 counties in South Carolina saw an uptick in influenza immunization rates, and from January to December 2015, all counties achieved higher pneumonia immunization rates.

Nevertheless, barriers still exist. Many seniors aren’t able to access clinics because they lack transportation, and more education is needed – particularly around the fact that Medicare Part D covers many vaccinations.

Given these needs, the coalition is looking to expand its efforts, using county-level data to determine where to target efforts.

In the fall of 2016, coalition members launched the next phase of their strategy, a partnership with Walgreens to host immunization clinics in rural areas. Through collaboration with Walgreens and other local stakeholders, the coalition has been successfully hosting three community events per quarter, with topics ranging from immunization awareness to assisted living options. They also have begun preparations for 2017 events, including a State Immunization Resolution, championed by pharmacist and Senator Ronnie Cromer, in March, and a statewide immunization day in August.

The coalition views culture-specific messaging as critically important moving forward, as it strives to continue the upward trend in immunization rates. “Family is very important in the South, especially among rural populations,” said Postal. “We’re finding that when we’re talking to seniors about getting vaccinated, it really hits home to say, ‘Do it for yourself, but also do it for your family and grandkids.’”

This story is one of 15 that were included in the 2016 QIO Program Progress Report. 

Providing Diabetes Self Management Education (DSME) to people with diabetes can significantly decrease the symptoms of the disease.

As the nation grows more culturally diverse, QIN-QIOs are facing new challenges in providing DSME resources to Medicare beneficiaries through the Centers for Medicare & Medicaid Services’ Everyone with Diabetes Counts (EDC) program. English is not the primary language of many beneficiaries across the nation. Often, a lack of English proficiency can inhibit a person’s ability to understand educational resources like DSME classes. Disparities in diabetes care have been attributed to cultural and language barriers.

Health Services Advisory Group (HSAG) – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Arizona, California, Florida, Ohio and the U.S. Virgin Islands – has addressed this changing cultural climate through language initiatives to provide comprehensive DSME to Medicare beneficiaries.

In states with large Hispanic populations like Arizona, California and Florida, providing DSME resources in both English and Spanish is now common practice for many DSME programs. The biggest challenge lies in providing resources in other languages for increasingly diverse populations. In California, HSAG has seen an increase in Asian language speakers. To meet their needs, HSAG coordinated the translation of DSME materials and classes for many languages, including Vietnamese, Mandarin, Hmong, Korean and others.

In California and Florida, certain Native American communities prefer to learn from teachers within their own communities. HSAG provides the training and support that Native American health ambassadors need in order for them to go back to their respective communities to educate beneficiaries about DSME.

‍In addition to accommodating the language needs of beneficiaries, HSAG’s outreach methods include high-touch strategies like conducting weekly phone calls, sharing facilitator cell phone numbers and sending handwritten greeting cards to increase retention rates in the program.‍

“High touch is a really important part of the Diabetes Empowerment Education Program,” says HSAG’s Laura Gamba, who works to recruit and provide DSME resources in Florida. “When someone is supposed to get a meter [to monitor blood sugar], for example, we follow up to make sure they know how to use it.” HSAG also has met beneficiaries in person at public locations to provide catch-up sessions if they missed a class.

HSAG recently partnered with the Food is Medicine program in the Tampa Bay area of Florida to encourage beneficiaries in lower-income communities to attend DSME classes. The Food is Medicine program offered $10 vouchers to each DSME class attendee for local fruits and vegetables from its Food is Medicine truck. This helped stimulate initial interest in the class, as well as improve retention rates, because people were given access to healthy foods in an accessible manner.

In total for 2016, HSAG graduated 5,201 beneficiaries from DSME programs, 4,736 of whom were Medicare beneficiaries.

This story is one of 15 that were included in the 2016 QIO Program Progress Report.

According to the Centers for Disease Control and Prevention (CDC), approximately 22 percent of Americans ages 65 and older have diabetes.

Diabetes Self-Management Education (DSME) is an ongoing process that facilitates the knowledge, skills and abilities necessary for diabetes self-care. Empowering people with the knowledge and ability to self-manage their diabetes through DSME can significantly improve their quality of life and long-term health.

atom Alliance – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Alabama, Kentucky, Indiana, Mississippi and Tennessee – has implemented a high-touch, community-oriented approach to promote DSME in both rural and urban coverage areas, through the Centers for Medicare & Medicaid Services’ Everyone with Diabetes Counts (EDC) program. Additionally, atom Alliance has identified community centers and locations at which beneficiaries frequently gather to enable ease of access to DSME programs. 

“One of the ways we engage beneficiaries is by going to their health care providers,” said Anthony Culver, Communication Specialist at atom Alliance. “However, meeting people where they are, like in community centers, libraries and senior centers, is often the best way to reach them.”

With this in mind, atom Alliance partnered with Methodist Healthcare’s Congregational Health Network in Memphis, Tennessee to promote DSME programs through its wide-reaching network of more than 600 congregations across the state of Tennessee.

atom Alliance works directly with 10 of Methodist’s health liaisons that are connected to the broad-reaching network of church groups, to promote various health engagement and education programs to the faith-based communities.‍

atom Alliance has found faith-based communities to be particularly effective in spreading the word about its DSME classes. “When we launch DSME at a new church, 10 or 15 people might show up,” said Debra Bratton, Quality Improvement Advisor at atom Alliance. “But when we host the second week of class, all those people bring a friend.” Bratton says the smaller, more intimate communities enable people who have benefited from DSME to become ambassadors for the program.

In rural Mississippi, providers have had difficulty getting beneficiaries to return to classes week after week to finish DSME courses. Often, lack of retention is due to barriers involving transportation or literacy. Through high-touch methods, atom Alliance has helped improve retention and provide necessary information to beneficiaries who do not have access to resources to attend the classes.

“You kind of have to be a detective,” says Trannie Murphy of atom Alliance-Mississippi. Dropout rates in rural areas can be high due to lack of transportation, so Murphy says the QIN-QIO calls individuals to remind them not to miss class and ensure they have a way to get there. Murphy says they also try to fill absentees in on what they missed or visit them at home to ensure beneficiaries are getting access to useful information.

Through these high-touch methods, atom Alliance has trained 370 beneficiaries in the state of Mississippi since the EDC program began coordinating DSME classes in 2015. As a QIN-QIO, atom Alliance has successfully educated 2,231 DSME graduates and trained 116 DSME trainers across all five states.

This story is one of 15 that were included in the 2016 QIO Program Progress Report.

The New England Quality Innovation Network-Quality Improvement Organization (QIN-QIO) – the QIN-QIO serving Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island and Vermont – works closely with the New Hampshire Department of Health and Human Services (NH DHHS) to implement Million Hearts® strategies across the state. As part of the regional New England Home Health Collaborative, together the New England QIN-QIO and NH DHHS have worked to implement smoking cessation – one of the “ABCS of Heart Health” – at the state level in New Hampshire.

One of the original challenges facing NH DHHS was a lack of home health clinician knowledge about smoking cessation resources for patients, and clinician uncertainty about how to approach the subject with them.

Through the New England QIN-QIO’s partnership with the NH DHHS, 11 home health agencies were connected to the New Hampshire Tobacco Prevention and Cessation Program. A tobacco treatment specialist offered to provide on-site education at the agencies to increase awareness among clinical staff about the health risks of smoking. The partners worked to connect clinical staff directly with patients.

‍Cornerstone VNA, a home health agency serving 35 communities in southern New Hampshire and Maine, spearheaded the smoking cessation initiative within its organization. A key manager at Cornerstone VNA was identified to enter patient data into the Home Health Quality Improvement (HHQI) National Campaign’s Home Health Cardiovascular Data Registry. Initially it was challenging for the manager to identify appropriate resources and the steps necessary to accomplish the goals. To help streamline the process, home health staff at the New England QIN-QIO created the “Road Map to Success Implementation Checklist” tool to help agencies better navigate the registry and its deadlines.‍

To implement the smoking cessation initiative, a dedicated quality improvement team at Cornerstone VNA identified the data needed based on the quality improvement measure it chose. In particular, team members needed to collect two pieces of information: whether the patient had been screened for tobacco use and whether smoking cessation education had been provided for at least three minutes. Once this data was collected, Cornerstone VNA was able to implement specific clinician interventions into a patient’s care plan.

Through the New Hampshire Tobacco Prevention and Cessation Program, Cornerstone VNA received a customized referral form to refer patients to the New Hampshire Tobacco Helpline. The program also provides smoking cessation patient education booklets, which the New England QIN-QIO shares with providers. “We are connecting patients with resources that we never knew were available. Clinicians are more comfortable asking about smoking cessation with patients and connecting them with the resources they need to be successful,” said Jennifer Gullison, RN, MSN, Clinical Director at Cornerstone VNA. 

Cornerstone VNA closely monitors HHQI data on a monthly basis to identify what additional education is needed for its patient population. The staff educator at Cornerstone VNA brings concerns to the clinical director and works to reeducate staff – all of whom are trained on the initiative – when they see numbers begin to rise. Since implementing the initiative, 100 percent of Cornerstone VNA patients have been screened, and patients who agreed to quit smoking have received education and resources.

This story is one of 15 that were included in the 2016 QIO Program Progress Report.

The TMF Quality Innovation Network – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Texas, Arkansas, Missouri, Oklahoma and Puerto Rico – has partnered with Greater Grace Church and a large health care provider system in the St. Louis area to reduce hypertension within the community using the American Heart Association’s (AHA) Check.Change.Control blood pressure program. Check.Change.Control focuses on educating participants about blood pressure and how to monitor and manage it.

The TMF QIN’s staff in Missouri works with churches and other faith-based organizations to provide tools and resources to educate their parishioners and others in the community about how to correctly monitor their blood pressure, what constitutes a heart-healthy diet and other tips. The QIN-QIO’s staff coordinates with church volunteers to help conduct blood pressure screenings and works with health care system staff to identify local and AHA resources to help church members live a healthier lifestyle.

Following initial blood pressure screenings, local volunteer health mentors, which TMF QIN staff have trained, follow up with participants and encourage them to continue monitoring their blood pressure and tracking their numbers. As a complement to the screening, the QIN-QIO offers diabetes self-management education through the Health for Life – Everyone with Diabetes Counts initiative, since high blood pressure is a risk factor for developing diabetes. 

During the first phase of the project, starting in August of 2015, 45 church members took advantage of the Check.Change.Control program. The second phase of the project began in the spring of 2016. During the “Spring into Better Health” session the program grew to 67 members, with a majority of the participants coming for more than one visit.

Following this success, Mercy Clinic East, a branch of the Accountable Care Organization representing Missouri, received the Million Hearts “Hypertension Control Champion” award for its activities in surrounding communities, in which Greater Grace and TMF QIN played a big part. The team used proven methods to accomplish these goals, including timely data, quick interventions, involving the patient in communication, and effective tools for comprehensive management of care.

TMF QIN’s staff in Missouri, along with partners under the Million Hearts® campaign, hope to continue improving population health with the launch of a diabetes self-management program in the spring of 2017.

This story is one of 15 that were included in the 2016 QIO Program Progress Report.

Behavioral health is a critical issue for the Medicare population. According to the Centers for Disease Control and Prevention(CDC), roughly 20 percent of older Americans experience a mental health condition such as anxiety, depression or bipolar disorder. In addition, the inappropriate use of prescription drugs and alcohol are becoming increasingly common, especially among older men. That group in particular experiences alarming rates of suicide. The CDC reports that men 75 and older have the highest rates of suicide per 100,000 people.  

HealthInsight – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Nevada, New Mexico, Oregon and Utah – is working in each of its states to better support primary care practices with resources and education to increase behavioral health screenings.

With over 800 practices spread out over a large geographic area, coordination is key. Throughout its network, HealthInsight has increased collaboration with local, state and national partners such as the National Alliance on Mental Illness (NAMI), Project ECHO™ (Extension for Community Healthcare Outcomes) programs, and government mental health authorities.

The QIN-QIO also has worked to raise awareness about the important role of primary care providers in the delivery of behavioral health screenings and other behavioral health services, especially in rural areas.

“Many Medicare beneficiaries feel more comfortable receiving mental health services from their primary care providers versus going to a community mental health center,” said Joan Gallegos, Project Manager at HealthInsight. “It’s been helpful to link primary care providers with the larger mental health services community to share resources and increase the level of service available to beneficiaries.”

To better support care providers, HealthInsight created a Practice Intervention Toolkit, a step-by-step guide of best practices, screening tools, and evidence-based strategies. They’ve also hosted a series of webinars for practices across all four of their states. Moving forward, the QIN-QIO is exploring ways to spread the word about the importance of screenings and the serious nature of behavioral health.

“We’re looking for spokespersons for behavioral health who can help get the message out in our states,” said Gallegos. “There’s so much stigma around these issues. To take this work to the next level, we need more education with the public about the impact and prevalence of behavioral health and substance abuse.”‍

This story is one of 15 that were included in the 2016 QIO Program Progress Report.

When a Medicare beneficiary with stage 5 chronic kidney disease (CKD) entered hospice in early 2016, the beneficiary’s family was concerned to learn that the necessary medications used for comfort care (known as a Comfort Kit) were not available when the patient had an increase in pain and shortness of breath the day after admission. The beneficiary’s family member subsequently contacted Livanta – the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) for that state – with a complaint about the lack of availability of the Comfort Kit and the resulting delay in comfort care. Livanta confirmed the quality of care concern and referred the case to Qualis Health – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Idaho and Washington – to help the hospice provider review the case and evaluate its improvement plan.

After performing a root cause analysis and a retrospective audit to identify any similar delays in medication access for comfort measures, the hospice quality team determined that the complaint represented a single isolated occurrence of a family’s dissatisfaction with the symptom management provided. The team consulted the Medicare Conditions of Participation and the state’s hospice and palliative care association, and determined that their organization was meeting national standards and its own standards of care. Yet, despite the absence of a systemic process problem, the team took the complaint seriously and assessed additional opportunities for quality improvement.

‍As they examined the process to acquire the Comfort Kit, hospice quality team members looked for opportunities to shorten the length of time between admission to hospice and the family’s receipt of a Comfort Kit. Originally, specialists and primary care physicians within the health care system ordered medications for hospice patients – a decentralized process that led to communication gaps and delays. Under the new streamlined process, the hospice physician group began ordering all scheduled drugs for hospice patients to improve efficiency. The hospice quality team also identified an alternative process for delivery of the Comfort Kit, using the health network’s transportation system to enable delivery within hours.‍

Improvements in acquisition and delivery processes further enabled the hospice provider to help families receive all medications in a timelier manner – not just Comfort Kits, but any medications urgently needed before the kit arrives or once drugs are initiated. Once hospice nurses assess the need for any urgent medications at the initial visit (and all ensuing visits), they can implement different delivery options based on need. Using a courier service, pharmacies close to the family’s residence, and volunteer staff, urgent medications can be processed and delivered in as little as one to two hours.

The hospice provider sent the QIN-QIO monthly reports monitoring patient complaints and has registered no complaints related to delays in receiving medications or concerns with symptom management for hospice care since the implementation of their plan.

“It’s important to recognize how a single complaint led to looking at an overall process – the process of ordering, receiving and delivering medications for all patients, beyond the Comfort Kit and beyond one family’s concern,” says Evan Stults, Communications Director for Qualis Health. “One complaint opened a window to identify and implement fundamental process revisions, and to share improvements in medication ordering and delivery within the whole system.”

This story is one of 15 that were highlighted in the 2016 QIO Program Progress Report.