Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
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Part II--Introduction: 6 Study Approach
Part II--Introduction: 6 Study Approach
Pages 143-159
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From page 143... ...
It evaluates the structural requirements, governance, and staffing of the individual QIOs, organizations holding QIO contracts, and the QIO Support Centers (QIOSCs)
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From page 144... ...
Chapter 10 evaluates the impact of quality improvement activities in the QIO program specifically. The detailed evaluation formulas as well as the means used to identify high performing QIOs are discussed.
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From page 145... ...
formed an authoring committee, the Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs, to prepare three reports in a single project and a separate subcommittee to focus on the Quality Improvement Organization (QIO) study and guide the data collection and analysis.
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From page 146... ...
The information presented in this report reflects the data collected through the midsummer of 2005 and is descriptive of the 8th SOW but does not include data reflecting the CMS and QIO work produced during the 8th SOW, which had barely begun when the report was drafted. The unit of analysis varied, depending on the questions addressed.
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From page 147... ...
The main data collection methods and sources for this study included the following: · a focused review of the literature on the impact of quality improvement and the impact of QIO efforts at quality improvement; · data collected in 2005 from all 53 QIOs through the SurveyMonkey internet-based data collection tool; · quantitative analyses of QIOs' relative performance on various subtasks of the 7th SOW; · site visits by 16 committee members and IOM staff to 11 QIOs and one CMS Regional Office; · telephone interviews with 20 CEOs from randomly selected QIOs; · a 3-day briefing by CMS staff; · a half-day workshop for the committee and subcommittee, including formal presentations from academic researchers as well as experts working in quality improvement in the field and comments from various stakeholders; · access to QIONet, a CMS internal website for the QIO program that includes performance data by state on the Dashboard section; · face-to-face interviews with CEOs and staff from certain QIOs and randomly selected QIO Support Centers (QIOSCs) ; · a focus group discussion with 11 QIO CEOs; · specific requests for data from CMS staff; · many formal and informal discussions with the staff of the American Health Quality Association (AHQA; the national organization representing all QIOs)
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From page 148... ...
The committee found most of the remaining studies by the use of Medline searches, performed in November 2004 for articles published in the previous 5 years, using the following medical search headings: "quality improvement," "effectiveness," and "intervention." In addition, the committee evaluated a selection of studies to supplement the evidence base for outcome measures, collaborative studies, audits and feedback, and evaluations of the QIO program published from November 2004 through July 2005. The committee chose studies from references in previously selected studies and by searching the Cochrane Database of Systematic Reviews and the Agency for Healthcare Research and Quality systematic reviews.
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This report includes only deidentified and aggregated data. Content of Data Collection Instrument Part 1 of the data collection instrument obtained information from each of the 41 organizations holding one or more QIO contracts for the 7th SOW.
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Respondents were asked to select a substantive answer whenever possible; a "don't know/prefer not to answer" response was offered as a backup. Approach to Data Collection The committee e-mailed a memorandum to the CEOs of all organizations holding QIO contracts for the 7th SOW.
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IOM staff reviewed both the notes and the presentations to identify themes, issues of concern to the QIOs, and useful ideas for further research. TELEPHONE INTERVIEWS To gain more insight into the views of the executive directors of the QIOs on their programs, Cheryl Ulmer, a health services research consultant working with the committee, interviewed CEOs from 20 of the 53 QIOs by telephone during March 2005.
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Nature of Interviews and Questions The committee developed an interview script with open-ended questions and then, while attending the AHQA national meeting in February 2005, conducted interviews with four CEOs not previously selected to pretest the interview protocol. Upon review of the interview notes and a discussion with the consultant, the committee developed a wide-ranging interview protocol that went beyond knowledge transfer and covered topics such as QIOSCs; the selection of identified participants; diffusion of knowledge about quality improvement activities beyond the identified participants; the pros and cons of targeting the poorest-performing providers; evaluation of the QIOs; the importance of beneficiary education, case review, and payment error functions; the impact of competition for QIO contracts; the timeliness and the quality of data; and barriers to knowledge transfer.
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From page 153... ...
Similarly, although there had been no specific questions on pay for performance or electronic health records, when these topics came up repeatedly, the consultant started asking the CEOs for their views. After the completion of all 20 interviews, the consultant analyzed the contents of her notes to identify the themes that emerged in response to each topic.
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From page 154... ...
THREE-DAY BRIEFING BY CMS The study's Project Officer at CMS, Joyce Kelly, arranged an intensive series of presentations by CMS staff, both those in the Central Office and those in the various QIO Regional Offices, that covered a wide range of elements of the QIO program. She worked with IOM staff in advance to develop the agenda, soliciting questions that the committee wanted addressed and proposing topics that CMS thought would be useful to the committee.
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From page 155... ...
All 11 CEOs agreed to participate, although one CEO recommended that the medical director be interviewed as a substitute. The participants represented at least two states from each Regional Office involved in the QIO program, including both predominantly rural and predominantly urban states.
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From page 156... ...
These surveys, further discussed in Chapter 10, were conducted among nursing homes, home health agencies, physicians offices, hospitals, and Medicare+Choice plans for all 53 QIOs in the 7th SOW. (For nursing homes and home health agencies, survey respondents included both identified participants and nonidentified participants.)
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NATIONAL CONFERENCES AND MEETINGS The committee gathered much information and understanding about the QIO program by attending national technical conferences held by CMS and AHQA, as well as smaller meetings sponsored by various organizations that focused more narrowly on particular aspects of the QIO program and related issues, such as public reporting of quality measures, information technology use in health care, and implementation of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Part D prescription drug benefit. A side benefit of the meetings was the opportunity for informal conversations with the employees of QIOs from across the country.
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From page 158... ...
The committee triangulated methods by checking the consistency of the findings obtained by the different data collection methods, such as the data collected through the web-based data collection tool, the focus group, the telephone interviews, and the site visits. Triangulation among data sources was also possible.
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From page 159... ...
Nonetheless, by using so many different methods to gather data, the committee strengthened its ability to paint a more complete and accurate picture of the QIO program. REFERENCES CMS (Centers for Medicare and Medicaid Services)
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