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: 30.39). 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.

1 Follower
  • Source
    [Show abstract] [Hide abstract]
    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 · 2.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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 01/2005; 27(2):79-90. · 2.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The US healthcare system provides evidence that spending more on healthcare does not result in better care, but also offers many lessons and surprises on how the quality and safety of healthcare can be improved. The US Institute of Medicine has clearly articulated what needs to be achieved. A series of US agencies, including the Joint Commission on Accreditation of Healthcare Organizations, the Centers for Medicare and Medicaid Services (CMS), other major players, and the Hospital Quality Alliance, routinely collect and report on numerous measures of the quality and safety of inpatient and outpatient healthcare. Most attention to improving care in the UK has focused on vertically integrated, closed healthcare systems, but the US experience provides additional models from the work of Quality Improvement Organizations and of numerous voluntary organisations that sponsor collaborative improvement.
    Clinical medicine (London, England) 11/2006; 6(6):551-8. DOI:10.7861/clinmedicine.6-6-551 · 1.69 Impact Factor


Available from