Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
Currently Skimming:
9 Impact of Technical Assistance for Quality Improvement and Knowledge Transfer
9 Impact of Technical Assistance for Quality Improvement and Knowledge Transfer
Pages 230-256
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 230... ...
QUALITY IMPROVEMENT The Quality Improvement Organizations (QIOs) seek to achieve quality improvement through the use of various interventions to enhance the efficiency and effectiveness of care received by Medicare beneficiaries.
|
From page 231... ...
Although health care quality improvement interventions have been discussed for decades, the emerging evidence base supporting their effectiveness remains sparse and therefore difficult to use as a basis for making policy decisions. Comprehensive studies of specific types of interventions are limited in part because of the many different methods of approaching quality improvement.
|
From page 232... ...
and a variety of care settings (physicians' offices and hospitals)
|
From page 233... ...
Also, a diminishing marginal effect of increased staff members was found on improvements of mortality rates. Although the evidence base for improvements in health care quality attributable to structural changes is emerging, it is sparse (Mark et al., 2004)
|
From page 234... ...
. Impact of QIO Quality Improvement Interventions with Providers The evidence about the impact of QIO quality interventions compared with the impact of other health care quality interventions is mixed.
|
From page 235... ...
IMPACT OF TECHNICAL ASSISTANCE 235 Process Measures Studies using process measures to evaluate the effects of QIO efforts to improve quality used a variety of designs: randomized controlled trial designs, quasiexperimental designs, cohort study designs, and cross-sectional study designs. These studies looked at the use of practice guidelines for the care processes for multiple conditions (diabetes, cardiovascular disease, and pneumonia)
|
From page 236... ...
. National Evaluations of QIO Technical Assistance Efforts Various reviews have evaluated various elements of the technical assistance provided by the QIO program, but none could ascribe the improvements directly to the efforts of the QIOs.
|
From page 237... ...
The effects of other quality interventions that were concur
|
From page 238... ...
. This does not mean that the QIO program is ineffective; rather, it is difficult to measure its effect separately, as is the case with quality improvement efforts in general.
|
From page 239... ...
More evidence is needed to identify these potential drivers. While the QIO program looks to further develop its quality improvement activities, some lessons can be gleaned from the rest of the industry.
|
From page 240... ...
· Collaborative methodology. The model for improvement has been extrapolated to the collaborative methodology, which refers to a semistructured gathering of providers from various health care organizations to improve a common process of care by sharing experiences, best practices, and lessons learned with each other (Ovretveit et al., 2002)
|
From page 241... ...
This is expected, because the QIO program strongly promoted the collaborative methodology during the 7th SOW. The survey responses showed familiarity with all methodologies, although familiarity with ISO 9000 and lean principles scored the lowest (49 and 45 percent, respectively)
|
From page 242... ...
Therefore, this study is unable to discern whether these positive effects are directly attributable to the QIO program, the collaborative methodology, a combination thereof, or other variables.
|
From page 243... ...
Knowledge transfer is not limited to interactions between researchers and providers or decision makers. In the QIO program, the participants in knowledge transfer include CMS, the QIOSCs, the QIOs, practitioners, administrators, and beneficiaries.
|
From page 244... ...
The next section discusses knowledge transfer in the general health care environment through an assessment of the literature, followed by a discussion of the multiple methods in which ideas are translated within the QIO program. Knowledge Transfer in the Literature As is the case for the health carerelated quality improvement intervention literature, the evidence base for knowledge transfer in health care is limited (Heller and Arozullah, 2001)
|
From page 245... ...
However, ideas are also exchanged between QIOs, among providers, from providers to QIOs, from QIO to QIOSCs, and from QIOSCs to CMS. Beneficiaries also play an integral role in this process through beneficiary education (the transfer of knowledge from QIOs and providers to beneficiaries)
|
From page 246... ...
Evaluation of QIOSC effectiveness by CMS will therefore be a function of satisfaction from both the Government Task Leaders and the QIOs. One approach used to transfer knowledge in the QIO program is the Process Improvement QIOSC, which was created in the 7th SOW and which has been renamed the Performance Improvement QIOSC in the 8th SOW.
|
From page 247... ...
, and the timing of the approval and distribution of the tools developed by the QIOSCs. In telephone interviews with 20 QIO CEOs, the QIOSCs received mixed reviews in terms of both expertise and timeliness.
|
From page 248... ...
Interventions often develop in the QIO program as part of pilot tests or special studies. An example of a successful pilot program was the Cooperative Cardiovascular Project, which began as a four-state pilot project in 1995 that was eventually implemented on a national scale.
|
From page 249... ...
. In the telephone interviews, the QIO CEOs also cited CMS working groups and meetings with CMS Regional Offices as methods of knowledge transfer.
|
From page 250... ...
CMS publicly reports data on the quality of care for individual nursing homes, home health agencies, and hospitals through its Compare websites (see Chapter 11)
|
From page 251... ...
In the 8th SOW, CMS added acceptance for publication in peerreviewed journals as an extra-credit point to the Hospital Payment Monitoring Program but not for other aspects of the SOW. Therefore, as QIOs are under performance-based contracts with limited time and resources, CMS provides little incentive to contribute to the literature.
|
From page 252... ...
· Although the quality of care received by Medicare beneficiaries has improved somewhat, researchers have been unable to attribute these changes to the QIO program. This can be the result of various limitations, such as how QIO interventions are currently evaluated or the fact that QIO interventions do not improve quality.
|
From page 253... ...
2005. From adversary to partner: Have quality improvement organizations made the transition?
|
From page 254... ...
2000. Quality of medical care delivered to Medicare beneficiaries: A profile at state and national levels.
|
From page 255... ...
2003. Improved diabetes care by primary care physicians: Results of a group-randomized evaluation of the Medicare Health Care Quality Improvement Program (HCQIP)
|
From page 256... ...
2005. Do quality improvement organizations improve the quality of hospital care for Medicare beneficiaries?
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.