Assessment of the Medicare Quality Improvement Organization Program

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   Appendix Figure 1. Locations of quality improvement organizations (QIOs).

   The size of each QIO is represented by the size of each star. Maine and Vermont QIO coverage is directed from the New Hampshire QIO office (Maine, New Hampshire, and Vermont are similar in QIO size).
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   Appendix Figure 2. Stratification of providers.

   Quality improvement organizations (QIOs) were required to recruit a limited number of nursing homes, home health agencies, and physician offices into identified participant groups (IPGs) for focused quality improvement interventions. Facilities not participating in the IPG for a given setting are labeled “non-IPG” for that setting. For a given quality measure, IPG nursing homes and home health agencies are subdivided into those focusing on a specified quality measure (IPG-select) and those not focusing on the specified measure (IPG-other). *Low-volume nursing homes and home health agencies and non–primary care physicians were not eligible for the IPG for contractual reasons.
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   Figure 1. Time-trend data for nursing home facilities: pressure ulcer (top) and daily physical restraints (bottom).

   Quarterly means were calculated from facilities with a reportable score in that quarter. Lower scores indicate better performance. Numbers in parentheses are the average numbers of facilities across quarters. IPG = identified participant group. For a given measure, the IPG-select subgroup consists of IPG providers that elected to focus on that measure, and the IPG-other subgroup consists of IPG providers that selected other measures.
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   Figure 2. Time-trend data for nursing home facilities: chronic care pain (top) and post–acute care pain (bottom).

   Quarterly means were calculated from facilities with a reportable score in that quarter. Lower scores indicate better performance. Numbers in parentheses are the average numbers of facilities across quarters. IPG = identified participant group. For a given measure, the IPG-select subgroup consists of IPG providers that elected to focus on that measure, and the IPG-other subgroup consists of IPG providers that selected other measures.
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   Figure 3. Time-trend data for nursing home facilities: decline in activities of daily living.

   Quarterly means were calculated from facilities with a reportable score in that quarter. Lower scores indicate better performance. Numbers in parentheses are the average numbers of facilities across quarters. IPG = identified participant group. For a given measure, the IPG-select subgroup consists of IPG providers that elected to focus on that measure, and the IPG-other subgroup consists of IPG providers that selected other measures.
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   Appendix Figure 3. Time-trend data for home health agencies: acute care hospitalization (top) and any emergent care (bottom).

   All rates are calculated as 12-month averages, ending with the last day of the month shown. “0” represents the 12-month period ending the month before the start of the contract. For the national group, the average number of facilities across all periods is given. All other groups include only home health agencies with valid data in the first and last time points shown. For these quality measures, lower scores indicate better performance. IPG = identified participant group; SOW = Scope of Work. For a given measure, the IPG-select subgroup consists of IPG providers that elected to focus on that measure, and the IPG-other subgroup consists of IPG providers that selected other measures.
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   Appendix Figure 4. Time-trend data for home health agencies: improvement in ambulation or locomotion (top) and improvement in bathing (bottom).

   All rates are calculated as 12-month averages, ending with the last day of the month shown. “0” represents the 12-month period ending the month before the start of the contract. For the national group, the average number of facilities across all periods is given. All other groups include only home health agencies with valid data in the first and last time points shown. For these quality measures, higher scores indicate better performance. IPG = identified participant group; SOW = Scope of Work. For a given measure, the IPG-select subgroup consists of IPG providers that elected to focus on that measure, and the IPG-other subgroup consists of IPG providers that selected other measures.
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   Appendix Figure 5. Time-trend data for home health agencies: improvement in confusion frequency (top) and improvement in management of oral medications (bottom).

   All rates are calculated as 12-month averages, ending with the last day of the month shown. “0” represents the 12-month period ending the month before the start of the contract. For the national group, the average number of facilities across all periods is given. All other groups include only home health agencies with valid data in the first and last time points shown. For these quality measures, higher scores indicate better performance. IPG = identified participant group; SOW = Scope of Work. For a given measure, the IPG-select subgroup consists of IPG providers that elected to focus on that measure, and the IPG-other subgroup consists of IPG providers that selected other measures.
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   Appendix Figure 6. Time-trend data for home health agencies: improvement in pain interfering with activity (top) and improvement in toileting (bottom).

   All rates are calculated as 12-month averages, ending with the last day of the month shown. “0” represents the 12-month period ending the month before the start of the contract. For the national group, the average number of facilities across all periods is given. All other groups include only home health agencies with valid data in the first and last time points shown. For these quality measures, higher scores indicate better performance. IPG = identified participant group; SOW = Scope of Work. For a given measure, the IPG-select subgroup consists of IPG providers that elected to focus on that measure, and the IPG-other subgroup consists of IPG providers that selected other measures.
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    Appendix Figure 7. Time-trend data for home health agencies: improvement in transferring (top) and improvement in upper-body dressing (bottom).

    All rates are calculated as 12-month averages, ending with the last day of the month shown. “0” represents the 12-month period ending the month before the start of the contract. For the national group, the average number of facilities across all periods is given. All other groups include only home health agencies with valid data in the first and last time points shown. For these quality measures, higher scores indicate better performance. IPG = identified participant group; SOW = Scope of Work. For a given measure, the IPG-select subgroup consists of IPG providers that elected to focus on that measure, and the IPG-other subgroup consists of IPG providers that selected other measures.
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    Appendix Figure 8. Time-trend data for home health agencies: stabilization in bathing.

    All rates are calculated as 12-month averages, ending with the last day of the month shown. “0” represents the 12-month period ending the month before the start of the contract. For the national group, the average number of facilities across all periods is given. All other groups include only home health agencies with valid data in the first and last time points shown. For this quality measure, higher scores indicate better performance. IPG = identified participant group; SOW = Scope of Work. For a given measure, the IPG-select subgroup consists of IPG providers that elected to focus on that measure, and the IPG-other subgroup consists of IPG providers that selected other measures.