Article

Assessment of the Medicare Quality Improvement Organization Program

Centers for Medicare & Medicaid Services, Baltimore, Maryland 21244-1850, USA.
Annals of internal medicine (Impact Factor: 17.81). 10/2006; 145(5):342-53. DOI: 10.7326/0003-4819-145-5-200609050-00134
Source: PubMed

ABSTRACT

Studies have shown improvement in quality of health care in the United States. However, the factors responsible for this improvement are largely unknown.
To evaluate the effect of the Medicare Quality Improvement Organization (QIO) Program in 4 clinical settings by using performance data for 41 quality measures during the 7th Scope of Work.
Observational study in which differences in quality measures were compared between baseline and remeasurement periods for providers that received different levels of QIO interventions.
Nursing homes, home health agencies, hospitals, and physician offices in the 50 U.S. states, the District of Columbia, and 2 U.S. territories.
Providers receiving focused QIO assistance related to quality measures and providers receiving general informational assistance from QIOs.
5 nursing home quality measures, 11 home health measures, 21 hospital measures, and 4 physician office measures.
For nursing home, home health, and physician office measures, providers recruited specifically by QIOs for receipt of assistance showed greater improvement in performance on 18 of 20 measures than did providers who were not recruited; similar improvement was seen on the other 2 measures. Nursing homes and home health agencies improved more in all measures on which they chose to work with the QIO than in other measures. Nineteen of 21 hospital measures showed improvement; in this setting, QIOs were contracted for improvement initiatives solely at the statewide level. Overall, improvement was seen in 34 of 41 measures from baseline to remeasurement in the 7th Scope of Work.
As in any observational study, selection bias, regression to the mean, and secular trends may have influenced the results.
These findings are consistent with an impact of the QIO Program and QIO technical assistance on the observed improvement. Future evaluations of the QIO Program will attempt to better address the limitations of the design of this study.

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Questions & Answers about this publication

  • Edwin D. Huff added an answer in Perioperative Nursing:
    Working in quality improvement for the operating room, what are some 'meaningful' performance measures you have used, possibly using EMR based data?
    Understanding and improving perioperative care delivery will benefit from measures that are actionable. I am interested in learning more about sample measures. EMR's have much to offer and I am interested in the use of actionable measures.
    Edwin D. Huff
    Timely and appropriate pre-op antibiotic administration has been a major measure in surgical QI done across the country under the Medicare QIO program. Dr. Dale Bratzler was the clinical leader, and has published a lot on the topic. See a link to his work by putting his name in the upper right search box.

    A summary view of some of the measures used can be found
    https://www.researchgate.net/publication/6878455_Assessment_of_the_Medicare_quality_improvement_organization_program?ev=prf_pub

    Best of actionable luck!
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      [Show abstract] [Hide abstract]
      ABSTRACT: Studies have shown improvement in quality of health care in the United States. However, the factors responsible for this improvement are largely unknown. To evaluate the effect of the Medicare Quality Improvement Organization (QIO) Program in 4 clinical settings by using performance data for 41 quality measures during the 7th Scope of Work. Observational study in which differences in quality measures were compared between baseline and remeasurement periods for providers that received different levels of QIO interventions. Nursing homes, home health agencies, hospitals, and physician offices in the 50 U.S. states, the District of Columbia, and 2 U.S. territories. Providers receiving focused QIO assistance related to quality measures and providers receiving general informational assistance from QIOs. 5 nursing home quality measures, 11 home health measures, 21 hospital measures, and 4 physician office measures. For nursing home, home health, and physician office measures, providers recruited specifically by QIOs for receipt of assistance showed greater improvement in performance on 18 of 20 measures than did providers who were not recruited; similar improvement was seen on the other 2 measures. Nursing homes and home health agencies improved more in all measures on which they chose to work with the QIO than in other measures. Nineteen of 21 hospital measures showed improvement; in this setting, QIOs were contracted for improvement initiatives solely at the statewide level. Overall, improvement was seen in 34 of 41 measures from baseline to remeasurement in the 7th Scope of Work. As in any observational study, selection bias, regression to the mean, and secular trends may have influenced the results. These findings are consistent with an impact of the QIO Program and QIO technical assistance on the observed improvement. Future evaluations of the QIO Program will attempt to better address the limitations of the design of this study.
      Full-text · Article · Oct 2006 · Annals of internal medicine
  • Edwin D. Huff added an answer in Public Health:
    I would like to receive any impression or information about health system evaluation based on primary health care.
    I am part of a group of researchers which is working on cities surrounding of our capital Brasilia. we are evaluating the health system of five satellite cities. My core is primary health care, does anyone have some experience in this field?
    Edwin D. Huff
    Carlos,

    Here are a three examples of published monitoring of health care quality that include outpatient - primary care components, in the United States:

    https://www.researchgate.net/publication/10953492_Change_in_the_quality_of_care_delivered_to_Medicare_beneficiaries_1998-1999_to_2000-2001?ev=pub_cit

    https://www.researchgate.net/publication/6878455_Assessment_of_the_Medicare_quality_improvement_organization_program?ev=prf_pub

    https://www.researchgate.net/publication/225303720_2011_National_Healthcare_Quality_Report?ev=prf_pub
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      [Show abstract] [Hide abstract]
      ABSTRACT: Despite widespread concern regarding the quality and safety of health care, and a Medicare Quality Improvement Organization (QIO) program intended to improve that care in the United States, there is only limited information on whether quality is improving. To track national and state-level changes in performance on 22 quality indicators for care of Medicare beneficiaries. National observational cross-sectional studies of national and state-level fee-for-service data for Medicare beneficiaries during 1998-1999 (baseline) and 2000-2001 (follow-up). Twenty-two QIO quality indicators abstracted from state-wide random samples of medical records for inpatient fee-for-service care and from Medicare beneficiary surveys or Medicare claims for outpatient care. Absolute improvement is defined as the change in performance from baseline to follow-up (measured in percentage points for all indicators except those measured in minutes); relative improvement is defined as the absolute improvement divided by the difference between the baseline performance and perfect performance (100%). The median state's performance improved from baseline to follow-up on 20 of the 22 indicators. In the median state, the percentage of patients receiving appropriate care on the median indicator increased from 69.5% to 73.4%, a 12.8% relative improvement. The average relative improvement was 19.9% for outpatient indicators combined and 11.9% for inpatient indicators combined (P<.001). For all but one indicator, absolute improvement was greater in states in which performance was low at baseline than those in which it was high at baseline (median r = -0.43; range: 0.12 to -0.93). When states were ranked on each indicator, the state's average rank was highly stable over time (r = 0.93 for 1998-1999 vs 2000-2001). Care for Medicare fee-for-service plan beneficiaries improved substantially between 1998-1999 and 2000-2001, but a much larger opportunity remains for further improvement. Relative rankings among states changed little. The improved care is consistent with QIO activities over this period, but these cross-sectional data do not provide conclusive information about the degree to which the improvement can be attributed to the QIOs' quality improvement efforts.
      Full-text · Article · Jan 2003 · JAMA The Journal of the American Medical Association

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