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


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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    • "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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    • "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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