Do Quality Improvement Organizations Improve the Quality of Hospital Care for Medicare Beneficiaries?

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2005; 293(23):2900-7. DOI: 10.1001/jama.293.23.2900
Source: PubMed

ABSTRACT Quality improvement organizations (QIOs) are charged with improving the quality of medical care for Medicare beneficiaries.
To explore whether the quality of hospital care for Medicare beneficiaries improves more in hospitals that voluntarily participate with Medicare's QIOs compared with nonparticipating hospitals. DESIGN, SETTING, AND DATA: Data from 4 QIOs charged with improving the quality of care in 5 states (Maryland, Nevada, New York, Utah, and Washington) and the District of Columbia were used. Hospitals participate with the QIOs on quality improvement on a voluntary basis. A retrospective study was conducted comparing improvement in the quality of care of patients in hospitals that actively participated with the QIOs vs hospitals that did not. The medical records of approximately 750 Medicare beneficiaries per state in each of 5 clinical areas (atrial fibrillation, acute myocardial infarction, heart failure, pneumonia, and stroke) were abstracted at baseline (1998) and follow-up (2000-2001).
Fifteen quality indicators associated with improved outcomes in the prevention or treatment of the 5 clinical areas were used as quality of care measures. These 15 indicators were specifically targeted by the QIOs for quality improvement during the study period.
Hospitals that voluntarily participate with the QIOs are more likely to be larger than nonparticipating hospitals (P<.05). At baseline, there were statistically significant (P<.05) differences between participating and nonparticipating hospitals on 5 of 15 quality indicators, with participating hospitals performing better on 3 of 5. There was no statistically significant difference in change from baseline to follow-up between participating and nonparticipating hospitals on 14 of 15 quality indicators. The one exception was that participating hospitals improved more on the pneumonia immunization indicator than nonparticipating hospitals (P = .005).
Hospitals that participate with the QIO program are not more likely to show improvement on quality indicators than hospitals that do not participate.

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    • "In particular, the reporting systems linked to payment, accreditation, and peer pressure from public benchmarking have made quality measurement and improvement higher priorities for hospital leadership and achieved better results [42]. Some conflicting findings show no effect on quality results [43-45]. From this evidence, we may conclude that besides the system weaknesses of quality measurement and reporting system itself, the impetus from external systems can stimulate positive results. "
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    ABSTRACT: The use of accreditation and quality measurement and reporting to improve healthcare quality and patient safety has been widespread across many countries. A review of the literature reveals no association between the accreditation system and the quality measurement and reporting systems, even when hospital compliance with these systems is satisfactory. Improvement of health care outcomes needs to be based on an appreciation of the whole system that contributes to those outcomes. The research literature currently lacks an appropriate analysis and is fragmented among activities. This paper aims to propose an integrated research model of these two systems and to demonstrate the usefulness of the resulting model for strategic research planning. To achieve these aims, a systematic integration of the healthcare accreditation and quality measurement/reporting systems is structured hierarchically. A holistic systems relationship model of the administration segment is developed to act as an investigation framework. A literature-based empirical study is used to validate the proposed relationships derived from the model. Australian experiences are used as evidence for the system effectiveness analysis and design base for an adaptive-control study proposal to show the usefulness of the system model for guiding strategic research. Three basic relationships were revealed and validated from the research literature. The systemic weaknesses of the accreditation system and quality measurement/reporting system from a system flow perspective were examined. The approach provides a system thinking structure to assist the design of quality improvement strategies. The proposed model discovers a fourth implicit relationship, a feedback between quality performance reporting components and choice of accreditation components that is likely to play an important role in health care outcomes. An example involving accreditation surveyors is developed that provides a systematic search for improving the impact of accreditation on quality of care and hence on the accreditation/performance correlation. There is clear value in developing a theoretical systems approach to achieving quality in health care. The introduction of the systematic surveyor-based search for improvements creates an adaptive-control system to optimize health care quality. It is hoped that these outcomes will stimulate further research in the development of strategic planning using systems theoretic approach for the improvement of quality in health care.
    BMC Health Services Research 10/2009; 9(1):195. DOI:10.1186/1472-6963-9-195 · 1.71 Impact Factor
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    • "From 1999 to 2002, QIOs began 13 projects that focused on diabetes screening and prevention. The effectiveness of these QIOs has not been thoroughly evaluated, and early research reported that hospitals participating in QIOs have the same outcomes in 14 of 15 quality indicators as hospitals that did not collaborate with QIOs (Snyder and Anderson 2005). "
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    ABSTRACT: Racial and ethnic minorities bear a disproportionate burden of the diabetes epidemic; they have higher prevalence rates, worse diabetes control, and higher rates of complications. This article reviews the effectiveness of health care interventions at improving health outcomes and/or reducing diabetes health disparities among racial/ethnic minorities with diabetes. Forty-two studies met inclusion criteria. On average, these health care interventions improved the quality of care for racial/ethnic minorities, improved health outcomes (such as diabetes control and reduced diabetes complications), and possibly reduced health disparities in quality of care. There is evidence supporting the use of interventions that target patients (primarily through culturally tailored programs), providers (especially through one-on-one feedback and education), and health systems (particularly with nurse case managers and nurse clinicians). More research is needed in the areas of racial/ethnic minorities other than African Americans and Latinos, health disparity reductions, long-term diabetes-related outcomes, and the sustainability of health care interventions over time.
    Medical Care Research and Review 11/2007; 64(5 Suppl):101S-56S. DOI:10.1177/1077558707305409 · 2.62 Impact Factor
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    • "The question of QIO effectiveness has remained elusive because of the difficulty of conducting rigorous studies that dem­ onstrate cause and effect (Jencks, Huff, and Cuerdon, 2003; Snyder and Anderson, 2005). QIOs clearly give CMS an important tool to influence quality outcomes, and ongoing evaluation of their effectiveness and improvement of that effectiveness is warranted. "
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    ABSTRACT: The 1965 legislation that established Medicare and Medicaid declared that the Federal Government would not interfere in clinical medicine. Despite the original intent, Medicare and Medicaid have had tremendous influence on medical practice. In this article, we focus on four policy areas that illustrate the influence of CMS (and its predecessor agencies) on medical practice. We discuss the implications of the relationship between CMS and clinical medicine and how this relationship has changed over time. We conclude with thoughts about potential future efforts at CMS.
    Health care financing review 12/2005; 27(2):79-90. · 2.06 Impact Factor
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