Assessment of the Medicare Quality Improvement Organization Program

5 September 2006 | Volume 145 Issue 5 | Pages 342-353

Background: Studies have shown improvement in quality of health care in the United States. However, the factors responsible for this improvement are largely unknown.

Objective: 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.

Design: Observational study in which differences in quality measures were compared between baseline and remeasurement periods for providers that received different levels of QIO interventions.

Setting: Nursing homes, home health agencies, hospitals, and physician offices in the 50 U.S. states, the District of Columbia, and 2 U.S. territories.

Participants: Providers receiving focused QIO assistance related to quality measures and providers receiving general informational assistance from QIOs.

Measurements: 5 nursing home quality measures, 11 home health measures, 21 hospital measures, and 4 physician office measures.

Results: 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.

Limitations: As in any observational study, selection bias, regression to the mean, and secular trends may have influenced the results.

Conclusions: 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.

Author and Article Information

From the Centers for Medicare & Medicaid Services, Baltimore, Maryland, Kansas City, Missouri, and Boston, Massachusetts; Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma; and Northeast Health Care Quality Foundation, Dover, New Hampshire.

Disclaimer: The opinions herein are those of the authors and are not necessarily those of the Centers for Medicare & Medicaid Services.

Disclosure: William Rollow, MD, MPH, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Acknowledgments: The authors acknowledge Judith B. Kaplan, MS, Centers for Medicare & Medicaid Services; Mark Gottlieb, PhD, New Mexico Medical Review Association; Meghan B. Harris, MS, Ohio KePRO; Michael J. McInerney, PhD, Mountain Pacific Quality Health Foundation; and Rodney J. Presley, PhD, Georgia Medical Care Foundation, for their insights and helpful suggestions. They also thank the data team at the Colorado Foundation for Medical Care (Kris Mattivi, Beth Stevens, Steve Anderson, and Laura Palmer) and Sean Hunt of Quality Insights of Pennsylvania for expert assistance in trending the nursing home and home health measures.

Grant Support: All funding for this work was provided by the Centers for Medicare & Medicaid Services.

Potential Financial Conflicts of Interest: All authors work for the federal government on administering the Medicare Quality Improvement Organization Program or work in a Quality Improvement Organization as one of the program contractors.

Requests for Single Reprints: William Rollow, MD, MPH, Centers for Medicare & Medicaid Services, Mail Stop S3-02-01, 7500 Security Boulevard, Baltimore, MD 21244-1850; e-mail, william.rollow{at}cms.hhs.gov.

Current Author Addresses: Drs. Rollow, Lied, and McGann, Mr. Poyer, and Mr. Kambic: Centers for Medicare & Medicaid Services, Mail Stop S3-02-01, 7500 Security Boulevard, Baltimore, MD 21244-1850.

Dr. LaVoie: Centers for Medicare & Medicaid Services, Kansas City Regional Office, 601 East 12th Street, Suite 235, Kansas City, MO 64106.

Drs. Bratzler and Ma: Oklahoma Foundation for Medical Quality, 14000 Quail Springs Parkway, Suite 400, Oklahoma City, OK 73134.

Dr. Huff: Centers for Medicare & Medicaid Services, Boston Regional Office, JFK Federal Building, Boston, MA 02203.

Dr. Ramunno: Northeast Health Care Quality Foundation, 15 Old Rollinsford Road, Suite 302, Dover, NH 03820.