Medicare's Quality Improvement Organization Program Maximizing Potential (2006) / Chapter Skim
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Appendix A Supporting Tables
Appendix A Supporting Tables
Pages 361-434
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Appendixes
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A Supporting Tables 363
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364 APPENDIX A TABLE A.1 Literature Review on Impact of Quality Improvementa Reference Data Source, Sample Size, and Time Frame Barr J, et al. "A Randomized Intervention · 1,908 women aged 5075 enrolled in a to Improve Ongoing Participation in northeast HMO who had a mammogram Mammography." The American Journal of with no subsequent visits for next 1821 Managed Care.
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telephone call with option Researchers suspect that its success to schedule appointment, and (3) regular publicity was due to convenience of scheduling campaign and personal aspect · The number of mammograms received after the · Mailings were not found to be intervention period and within 2 years of the initial useful mammogram · Limitations: this group of women may have been hard to motivate or had mammograms outside of the health plan · Assess whether or not physician opinion leaders · Use of OLs results in small, (OL)
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" management directors Health Services Research.
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· QIOs are seen more as collaborative partners than as adversaries, as they were stigmatized in the past · Many believed that QIOs could be more effective at attaining more support from physicians and senior management of hospitals · Determine improvement in quality of care for · Quality improved overall between AMI the two periods · Analyzed data from CCP. Quality indicators · In practice, some types of quality studied: early administration of aspirin, aspirin indicators are more readily improved prescribed at discharge, early administration of than others (i.e., reperfusion therapy beta-blockers, beta-blocker prescribed at discharge, and smoking cessation counseling)
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"Improving the Quality of · Medical record abstraction Care for Patients with Pneumonia in Very · 36 hospitals, mostly rural community Small Hospitals." Archives of Internal hospitals, in Oklahoma Medicine.
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Two intervention more likely to show statistical cycles. Interventions consisted of QIO providing improvement in process measures hospitals feedback via face-to-face meetings with than control group medical staff and individual hospital profiles; No statistically significant hospitals had to provide QIO with quality differences in outcomes measures improvement plans.
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"The Impact of Quality · MDS reports of restraint use Improvement Programs in Long Term · Population statewide in LTC facilities, Care." Texas Department of Human 69,59070,814 patients Services.
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The difference in observed · Estimated excess fraction of improvement between the QIO subgroup and the improvement attributable to the QIO remaining facilities is the fraction attributable to program: 19.8% the QIO intervention · Statewide, 90% of improvement is · Change in restraint prevalence among facilities attributable to the DHS program; receiving QIO TA and those receiving DHS TA 10% is attributable to QIO because only QIO served only 13% of facilities statewide · Conclusion: state and QIO programs are not redundant and the programs are complementary · Assess effect of collaboratives at state level; test · State-level collaboratives effective what efforts may be associated with quality Provided more technical support improvement Increased participation · Teams independently collected data on process · Higher absolute improvement and outcomes of clinical indicators of diabetes associated with teams with lower care; over 13-month test period, teams congregated baseline levels at four conferences, sharing lessons learned · Process measures had greater · Indicators of success: absolute improvement absolute improvement, perhaps due (from baseline to remeasurement) and to behavioral changes, which are improvement in remeasurement values necessary by both providers and patients continues
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"Impact of Quality · 117 acute care hospitals in Iowa Improvement Activities on Care for Acute · Baseline: June 1992December 1992 Myocardial Infarction." International Follow-up: August 1995November 1995 Journal for Quality in Health Care.
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· Cannot fully validate the measures used due to a lack of standard criteria · CCP quality indicators showed areas for improvement, but quality indicators need to be refined · Assess relationship between PRO-involved · Found significant (p < 0.05) quality improvement activities and improvement in improvement only for three quality of care of AMI treatment indicators from baseline (aspirin · Two groups: treatment during stay, aspirin Hospitals with no plan or no systematic change treatment at discharge, and betato improve AMI care (73 hospitals)
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"Alabama Coronary · Medical record abstraction Artery Bypass Grafting Project." JAMA. · Alabama: 5,784 patients 2001.
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Process measures may produce pocket reminder cards, and promote have been more successful due to standardized orders; analyzed antibiotic use, more evidence and fewer discharge rates prior to clinical stability, length of confounders stay, timely switch to oral antibiotics, and timely discharge · Statistical difference from pre- and postinterventions of process and outcomes measures · Assess quality improvement efforts for CABG in · Significant differences were seen in 20 Alabama hospitals Alabama's improvement in · Held meetings with all hospitals in Alabama that comparison with those of both the performed CABG to provide peer-based feedback comparison state and the national and share care processes; measured process and standard (p < 0.02 for all measures, outcomes indicators from baseline to follow-up p < 0.001 for some) and compared them with those from a national · Risk-adjusted mortality OR: 0.72 sample and a comparison state and 0.76 compared with comparison · Mean change from baseline to follow-up; ORs state and national sample, calculated for mortality respectively continues
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"Change in the Quality of · Medical record abstraction Care Delivered to Medicare Beneficiaries, · Results from 52 QIOs (does not include 19981999 to 20002001." JAMA.
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· Much room for improvement, · Measure performance of the median state (not according to the 24 measures the national average) , rank of states for each · Need to focus on systems change, measure, and average overall ranking, with not individual practitioner geographic trends also evaluated; clinical topics · General geographic trend: higherwere chosen for their potential for substantial quality ranking associated with effect on quality northern and less populated states · Percentage of people receiving appropriate care · Impossible to attribute changes in for 22 indicators of heart failure, stroke, indicators to QIO activities pneumonia, breast cancer, and diabetes, as defined by CMS, ACC/AHA, ATS, BRFSS, HEDIS, DQIP, and CDC · Track changes for 22 quality measures at state · Care for Medicare fee-for-service and national levels and outpatient beneficiaries increased · Compared results in 19981999 per state per for 20 of 22 measures measure with results in 20002001; states were · Generally, states with lower also ranked based on performance improvement.
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"Improving Care for · Medical records from hospitals and PROs Medicare Patients with AMI." JAMA.
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APPENDIX A 379 Study Purpose, Methodological Approach, and Outcome Measures Findings · Determine if providing feedback to physicians for · Physician performance improved quality improvement is enhanced by use of when feedback was combined with benchmarking benchmarks · Randomized controlled trial where the control · Significant improvements were group physicians received feedback based on chart made by the experimental group over review and the intervention group feedback also the control group in reception of flu included benchmarking vaccine (OR = 1.57) , foot exams (OR · Odds ratios were calculated = 1.33)
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"Improved Diabetes · 22,971 Medicare diabetes patients; 477 Care by Primary Care Physicians: Results of PCPs in 123 counties in rural Georgia a Group-Randomized Evaluation of the · Baseline: JanuaryDecember 1996 Medicare Health Care Quality Improvement Follow-up: January 1998December 1999 Program." Journal Clinical Epidemiology.
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Absolute practice guidelines for stroke and cardiovascular difference = 6% (p > 0.2) disease · 22.4% and 16.4% improvement by · Distributed practice guidelines and performance intervention and control groups, reports quarterly to all providers; randomized respectively controlled trial: half of the practices participated in · Limitation of small n and lack of quarterly visits and annual meetings to share best true control group practices · Percentage of indicators meeting target of 90% adherence for each indicator continues
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"Evaluation of Quality · Medical record abstraction Improvement Interventions for Reducing · 14 states (7 control states, 7 intervention Adverse Outcomes of Carotid states) matched by number of beneficiaries Endarterectomy." Medical Care.
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. for those with above or below average rates at · Potential lack of physician 95% confidence understanding and support of quality · Change in quality indicators (measured in improvement efforts proportions of patients)
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ABBREVIATIONS: ACC = American College of Cardiology; ACE = angiotensin-converting enzyme; AHA = American Heart Association; AHRQ = Agency for Healthcare Research and Quality; AMI = acute myocardial infarction; ANOVA = analysis of variance; ATS = American Thoracic Society; BRFSS = Behavioral Risk Factor Surveillance System; CABG = coronary artery bypass grafting; CCP = Cooperative Cardiovascular Project; CDC = Centers for Disease Control and Prevention; CEA = carotid endarterectomy; CMS = Centers for Medicare and Medicaid Services; DQIP = Diabetes Quality Improvement Project; EKG = electrocardiography;
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and by itself; may be more effective than audit and feedback · Results are mixed HbA1c = hemoglobin A1c; HCQIP = Health Care Quality Improvement Program; HCUP = Healthcare Cost and Utilization Project; HEDIS = Health Plan Employer Data and Information Set; HMO = health maintenance organization; ICD-9 = International Classification of Diseases9; LTC = long term care; LVSD = left ventricular systolic dysfunction; MDS = Minimum Data Set; OR = odds ratio; OSCAR = Online Survey, Recertification, and Reporting; PCP = primary care provider; PRO = Peer Review Organization; QI = quality improvement; QIO = Quality Improvement Organization; TA = technical assistance.
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QI x NOTE: QI = quality improvement; QIO = Quality Improvement Organization.
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R (optional) R Infections R Pressure sores High risk R R R Low risk R Restraint use R R R Depression or anxiety R R worsening Incontinence Urinary tract infections Indwelling catheters Weight loss Post acute care Pain R Pressure sores R Delirium symptoms R Improved in walking R NOTE: = required performance measure; R = required performance measure that is reported to the public by the Centers for Medicare and Medicaid Services (CMS)
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388 APPENDIX A TABLE A.3b Comparison of Quality Improvement Organization (QIO) Performance Measures and Measures Recommended by Institute of Medicinea for Task 1b -- Home Health QIO -- QIO- 8th SOW 7th SOW Statewide Statewide Performance and Clinical and Identified Measurec Performance Measure Performance IPGb Participants Starter Set Chronic care Activities of daily living Stabilization in bathing R Post acute care Activities of daily living Improvement in dressing upper body R Improvement in bathing R R Management of oral medications R R Getting around Improvement in toileting R Improvement in ambulation/ R R locomotion Improvement in transferring R R Improvement in pain interfering R R with activity Physical health Improvement in dyspnea Improvement in status of surgical wounds Improvement in urinary incontinence Mental health Improvement in cognitive functioning Improvement in confusion frequency Staying at home without home care Discharged to community Prevalence measures Acute care hospitalization R R Emergent care R NOTE: = required performance measure; R = required performance measure that is reported to the public by the Centers for Medicare and Medicaid Services (CMS)
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APPENDIX A 389 TABLE A.3c Comparison of Quality Improvement Organization (QIO) Performance Measures and Measures Recommended by Institute of Medicinea for Task 1c -- Hospital Setting QIO- QIO -- 8th SOW 7th SOW Task Task Statewide 1c1: 1c1: Task and Performance ACM SCIP 1c2: Identified Measureb Performance Measure Statewide IPG IPG CAH Participants Starter Set Surgical complications Infection On-time prophylactic *
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390 APPENDIX A TABLE A.3c Continued QIO- QIO -- 8th SOW 7th SOW Task Task Statewide 1c1: 1c1: Task and Performance ACM SCIP 1c2: Identified Measureb Performance Measure Statewide IPG IPG CAH Participants Starter Set Cardiovascular Major noncardiac * surgery patients received beta-blockers during perioperative period Major surgery patients *
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APPENDIX A 391 TABLE A.3c Continued QIO- QIO -- 8th SOW 7th SOW Task Task Statewide 1c1: 1c1: Task and Performance ACM SCIP 1c2: Identified Measureb Performance Measure Statewide IPG IPG CAH Participants Starter Set Respiratory Postoperative orders and * documentation of elevation of Head of Bed Postoperative ventilator associated pneumonia during index hospitalization Peptic ulcer disease *
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392 APPENDIX A TABLE A.3c Continued QIO- QIO -- 8th SOW 7th SOW Task Task Statewide 1c1: 1c1: Task and Performance ACM SCIP 1c2: Identified Measureb Performance Measure Statewide IPG IPG CAH Participants Starter Set Acute myocardial infarction (continued) Beta-blocker prescribed at *
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= required performance measure; the Centers for Medicare and Medicaid Services (CMS) evaluates the QIOs only on these particular measures in assessing identified participant groups of Task 1c1 and all providers for Task 1c2.
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b UP Participants Starter Set Preventive care Tobacco cessation counseling Tobacco use Prevention Cholesterol screening R Blood pressure R Colorectal cancer screening R Breast cancer screening R,V R Cervical cancer screening Pneumococcal vaccine R,V R Influenza vaccine R,V R Prenatal Care Anti-D immune globulin Screening for human immunodeficiency virus Acute care Acute myocardial infarction Aspirin treatment at V arrival for acute myocardial infarction Beta-blocker treatment at V time of arrival for acute myocardial infarction Pneumonia Antibiotic administration V timing for patient hospitalized for pneumonia Surgery Antibiotic prophylaxis V Thromboembolism V prophylaxis Use of internal mammary V artery in coronary artery bypass graft (CABG) surgery Preoperative beta-blocker V for patient with isolated CABG
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test HbA1c control V R Urine protein testing R Lipid profile R R Low-density lipoprotein (LDL) cholesterol screening LDL control V Adults diagnosed with diabetes with most recent blood pressure <140/90 mm Hg High blood pressure control V Eye exam R R Foot exams R End-stage renal disease Dialysis dose V Hematocrit level V Receipt of autogenous V ateriovenous fistula Coronary Artery Diseasee Antiplatelet therapy V R Drug therapy for lowering R LDL cholesterol LDL control V Beta-blocker therapy -- V R prior myocardial infarction Angiotensin-Converting R Enzyme inhibitor therapy continues
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396 APPENDIX A TABLE A.3d Continued QIO- QIO -- 8th SOW 7th SOW Task Statewide 1d1: Task and Performance Task 1d1: IPG (1 1d2: Identified Measurec Performance Measure Statewide and 2) b UP Participants Starter Set Heart failure Weight measurement R Patient education R Beta-blocker therapy V R Warfarin therapy for V R patients with atrial fibrillation Left ventricular ejection R fraction testing Left ventricular function assessment ACE inhibitor/Angiotensin V II-Receptor Blocks therapy for left ventricular systolic dysfunction Asthma Use of appropriate medications Pharmacologic therapy Depression Acute Antidepressant V medication management Chronic Antidepressant V medication management Osteoporosis Screening in elderly female V patient Prescription of calcium and V vitamin D supplements Antiresorptive therapy or V parathyroid hormone treatment, or both, in patients with newly diagnosed osteoporosis Bone mineral density testing V and osteoporosis treatment and prevention following osteoporosis-associated nontraumatic fracture
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eIdentified participant groups are evaluated in part on the basis of having met target levels of performance for coronary artery disease.
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Washington, DC: The National Academies Press. CAHPS = Consumer Assessment of Healthcare Providers and Systems; HEDIS = Health Plan Employer Data and Information Set.
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Projects Multiple $9,257,769 MedQIC Website -- Transition from Delmarva to IFMC IA $3,980,548 Quality Improvement Interventions Support QIO VA, MD $1,263,774 Training QIOs in human factors UT $350,000 Nursing Home Initiative Ads IA $2,800,000 Home Health Initiative Ads IA $3,000,000 Hospital Initiative Ads WA $3,000,000 TOTAL SUPPORT SEVENTH SOW CORE WORK $67,026,739 Learning from innovative quality improvement approaches in nursing homes WI $975,000 Health Care Collaborative Network Project CO $200,000 Doctor's Office Quality -- Information Technology CA $11,000,000 HHA Outcomes-Based Quality Improvement Evaluation UT $350,000 Surgical Complications OH, KY $3,009,672 Achievable NH targets for pressure ulcers & restraints RI $218,008 Depression projects NY, MI $1,046,000 CMS colorectal cancer screening NC $58,914 Physician's office registry development MD $35,000 Health outcomes survey AZ $3,600,000 Hospital public reporting pilot projects AZ $3,131,453 Patient safety learning pilot projects: IN, NV, UT, WI Multiple $1,874,056 Medicare Patient Safety Monitoring System (excluding CDACs) CT $786,031 Medicare Patient Safety QIOSC CT $1,998,290 Rural Antibiotic (RADAR)
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400 APPENDIX A TABLE A.4a Continued Project Title QIO Award Chronic Kidney Disease Pilot Intervention GA $299,957 Rural Hospital Quality Measures MN $351,436 Quality of Care in Community Health Centers Using Health TN $146,377 Care Facilitators Identify New Areas of Disparity Work for Eighth SOW TN $131,104 Information Collection on Past/Potential Disparity Projects TN $118,380 Cervical Cancer Mortality TN $18,161 Physician Office Registry Development MT $4,000,000 Rebuild MedQIC Website like IHI's QHC.org IA $910,000 Best Practices in QIOs to Help Providers Improve Quality WA $2,795,610 Measures Case Studies -- High Performers AZ $800,000 Statistical Support IA $636,710 Process Improvement QIOSC WA $1,287,910 New England Complex Systems Institute UT $100,000 Negative or Positive Public Reporting of Measures MD $93,979 Review of Managed Care Organization Required National NY, CA, MD $1,032,526 Quality Projects BIPA Notice of Proposed Rulemaking Grijalva IN $403,000 ESRD Facility Specific Reports (Dialysis Compare) WA $1,449,000 CAHPS Nursing Home AZ $1,300,000 Presenting Accurate Nursing Home Staffing Ratios CO $671,049 Continue Hospital Core PM Project MS $553,360 Measures Management AZ $1,301,638 Continuation of Pharmaceuticals Project MS $1,200,000 Development of Robust Measure Set Phase I NY $412,722 Voluntary Hospital Reporting (Setting Priorities)
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WA $100,000 Cross-Setting Collaborative to Enhance Home Health Service MD $330,000 Utilization Spreading the Patient Safety Learning Pilot -- IN/WI IN, WI $425,000 Optimizing the HCQIP Strategic Plan -- Process Improvement WA $249,222 Training Determination of payment errors for improper billing of short-stay outliers for long-term acute care stays Multiple $209,876 Emergency Department Quality Measures Pilot Test WA $150,000 TOTAL DEVELOPMENTAL/SPECIAL PROJECTS $63,795,467 TOTAL APPROVED DEVELOPMENTAL/SUPPORT QIO $130,822,206 PROJECTS SOURCE: Personal communication, C Lazarus, March 17, 2005.
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$534,240 5080 Healthy Aging Project $5,886,150 5081 Citizen Advocacy Center Training and Support $266,978 5082 Study and Development of QIO Best Practices $1,489,678 5083 PRO Mediation Training & Internal Quality Control $792,238 5084 Vista $100,000 5085 Clinical Data Abstraction Center (CDACs) Abstraction for CHF QAPI $1,107,250 5086 HL7 Standards Setting Process $100,000 5087 QIO Subtask Certification $149,986 5100 Data Accuracy and Verification $1,766,593 5200 ESRD CAHPS $165,000 5202 CAHPS $33,439,343 5217 Prevention Initiatives $799,993 5218 Website Quality Support $3,087,000 5220 Promotion, Quality, Consumer Research $5,381,777 5402 Influenza/Pneumococcal Vaccination Campaign $1,708,164 5403 Mammography Campaign $1,523,745 5501 National Quality Forum Collaboration $749,524 5502 Doctors Office Quality Improvement Project Collaboration with AMA $20,000 5503 Physician Measurement in Managed Care and Fee for Service $1,422,803 5505 ESRD Performance Measures $2,061,236 5506 Home Health Outcomes Based Quality Improvement $300,000 continues
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APPENDIX A 403 TABLE A.4b Continued Contract Number Proposed Activity/Project 3-Year Total 5507 Home Health Quality Measurement & Refinement $1,299,673 5508 Minimum Data Set (MDS) 3.0 Development $4,420,840 5509 HEDIS Health Outcomes Survey $4,249,170 5510 ESRD Patient Survey $500,000 5511 Pittsburgh Research Initiative $1,499,740 5513 ESRD Public Reporting Initiative $248,532 5514 Analysis Contract $449,864 5515 Senior Risk Reduction $3,291,258 5516 Hospital Satisfaction Survey $1,700,000 6149 Validation of Managed Care Data for Risk Adjustment $6,388,706 5081 B Systematized Nomenclature of Medicine $350,000 Total $243,486,514 SOURCE: Personal communication, C
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Delirium (with additional risk adjustment) Provider satisfaction Task Setting CMS Priority Performance Measures 1b Home health Health status 11 OBQI/OASIS measuresc (getting improvement dressed, bathing, confusion, medication management, ambulation, toileting, transferring, pain when moving, emergency care, acute hospitalization)
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APPENDIX A 405 Statewide Improvement Identified Participant Improvement Target Scoring Weightsa Target Scoring Weightsa 8% averaged 0.8 -- identified 8% averaged 0.44 × (actual improvement on participant score improvement on improvement/target three to five publicly three to five improvement) reported quality-of- publicly reported care measures quality-of-care measures 80% "satisfied" 0.05 80% "satisfied" 0.15 response rate response rate Statewide Improvement Identified Participant Improvement Target Scoring Weightb Target Scoring Weightb N/A 30% of HHAs in the 0.8 state must have statistically significant improvement in at least one OBQI / OASIS measure 80% "satisfied" 0.05 80% "satisfied" 0.15 response rate response rate continues
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406 APPENDIX A TABLE A.5 Continued Task Setting CMS Priority Performance Measures 1c Hospital Clinical measures Acute myocardial infarction, heart failure, pneumonia, and surgical infection Provider satisfaction Task Setting CMS Priority Performance Measures 1d Physician's office Chronic disease care Biennial retinal exam, annual (diabetes) hemoglobin A1c testing, biennial testing of lipid profile Preventive services Biennial screening mammography (cancer screening)
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APPENDIX A 407 Statewide Improvement Identified Participant Improvement Target Scoring Weightsd Target Scoring Weightsd 8% improvement in 0.75 N/A combined topic average (average score for a condition, based on improvement in the four sets of indicators) 80% "satisfied" response rate 0.25 Statewide Improvement Identified Participant Improvement Target Scoring Weightse Target Scoring Weightse 8% improvement in 0.8 -- identified 8% improvement in 0.44 × (actual combined topic participant score diabetes and cancer improvement/target averagef screening measures improvement)
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, its contract will be reevaluated by a Centers for Medicare and Medicaid Services panel. OBQI/OASIS = Outcome-Based Quality Improvement/Outcome and Assessment Information Set; N/A = not applicable; HHA = Home Health Agency; QAPI = Quality Assessment and Performance Improvement.
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. The weighted average of Health Plan Empoyer Data and Information Set data will be used to derive diabetes and mammography measures of rates for Medicare+Choice organizations(if applicable)
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410 APPENDIX A TABLE A.6 Evaluation of Task 1a in 8th SOW Dimension of Task Setting Performance Performance Measures 1a Nursing home Clinical performance Pressure ulcers among high-risk residents measure resultsb Physical restraints Management of depressive symptoms Management of pain in chronic (long stay) residents
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APPENDIX A 411 Statewide Improvement Identified Participant Improvement Scoring Weights Scoring Weights Targets (18% of totala) Targets (82% of totala)
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412 APPENDIX A TABLE A.6 Continued Dimension of Task Setting Performance Performance Measures Process improvement Extra credit: Process change implementation Organization culture Target settingb change
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APPENDIX A 413 Statewide Improvement Identified Participant Improvement Scoring Weights Scoring Weights Targets (18% of totala) Targets (82% of totala)
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414 APPENDIX A TABLE A.6 Continued Dimension of Task Setting Performance Performance Measures Data collection on experience of careb Satisfaction and knowledge/ perceptionb Dimension of Task Setting Performance Performance Measures 1b Home health Clinical performance OASIS publicly reported measurese measure resultsd Acute care hospitalization
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RFR for one QIO- 10% of total score must meet or 9% of total score selected measure exceed identified OASIS publicly participant group reported measure target RFR for one home health agencyselected measureb Meet or exceed 30% 0.19 (0.22 max) Average rate of group 0.27 (0.32 max)
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416 APPENDIX A TABLE A.6 Continued Dimension of Task Setting Performance Performance Measures Systems improvementb Telehealth Process improvement Immunization assessment surveyb Incorporation of immunizations into computer Organization culture Survey tool to measure organizational change culture change
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on the percentage of home health agencies that incorporated influenza or pneumococcal immunizations, or into comprehensive patient assessments Implement CMS 0.02 survey tool 2% of total score Implementation 0.04 of quality 4% of total score improvement activity and submission of a plan of action based on results of organizational culture change survey continues
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418 APPENDIX A TABLE A.6 Continued Dimension of Task Setting Performance Performance Measures Organization culture Extra credit: Target setting change Satisfaction and knowledge/perception Dimension of Task Setting Performance Performance Measures 1c1 Hospital Clinical performance Appropriate care measureb,g measurement results Clinical performance Measures reportingb measurement and reporting Assistance to hospitals to ensure data are timely, valid, and completeb Process improvement Surgical Care Improvement Project (SCIP)
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At least 25% of non- Extra credit: 0.07 At least 50% of Extra credit: 0.05 identified participant identified participant group home health group home health agencies set targets agencies set targets for acute care for acute care hospitalization and hospitalization and other OASIS other OASIS measures measures At least 80% score 0.1 on satisfaction and 10% of total score knowledge/perception surveys Statewide Improvement Identified Participant Improvement Scoring Weights Scoring Weights Targets (27% of totalf) Targets (73% of totalf)
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420 APPENDIX A TABLE A.6 Continued Dimension of Task Setting Performance Performance Measures Systems improvement Use of CPOE, bar coding, or telehealthb Satisfaction and knowledge/perceptionb Dimension of Task Setting Performance Performance Measures 1c2 Critical access Clinical performance One quality improvement measure hospital or measure results selected by each critical access hospital rural hospital Clinical performance Reporting of Hospital Quality Alliance measurement and measure seth reporting
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APPENDIX A 421 Statewide Improvement Identified Participant Improvement Scoring Weights Scoring Weights Targets (27% of totalf) Targets (73% of totalf)
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422 APPENDIX A TABLE A.6 Continued Dimension of Task Setting Performance Performance Measures Extra credit: Reporting on transfer measures for new acute myocardial infarction and/or emergency department Systems improvement Use of CPOE, bar coding, or telehealth Organizational change Hospital safety culture assessment Satisfaction and knowledge/perceptionb
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APPENDIX A 423 Statewide Improvement Identified Participant Improvement Scoring Weights Scoring Weights Targets (64% of totalj) Targets (36% of totalj)
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424 APPENDIX A TABLE A.6 Continued Dimension of Task Setting Performance Performance Measures 1d1 Physician Clinical performance Statewide support for Physician practice measure results Voluntary Reporting Programg Statewide quality improvement by working with public health, provider groups, and others to support prevention and disease-based care processes Assistance to Medicare Advantage plans Assistance to End-Stage Renal Disease Networks Medicare Management Demonstration Project Clinical performance Export data measurement and reportingm Process improvementm Care management process to meet individual's health needs through the practice site systems survey Systems improvementm Production and use of information from electronic systems Satisfaction and knowledge/perceptionb
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APPENDIX A 425 Statewide Improvement Identified Participant Improvement Scoring Weights Scoring Weights Targets (17% of totall) Targets (83% of totall)
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426 APPENDIX A TABLE A.6 Continued Dimension of Task Setting Performance Performance Measures 1d2 Underserved Clinical performance Claims-based clinical measuresg populations measure results Clinical performance Task 1d1 activities measurement and reporting Systems improvement Promotion of culturally and linguistically appropriate service (CLAS) standards Process improvement Cultural competency education Satisfaction and knowledge/perceptionb
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APPENDIX A 427 Statewide Improvement Identified Participant Improvement Scoring Weights Scoring Weights Targets (35% of totaln) Targets (65% of totaln)
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bCore activities. If a QIO does not complete these specific activities, its contract may be subject to reevaluation by a Centers for Medicare and Medicaid Services panel.
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APPENDIX A 429 Statewide Improvement Identified Participant Improvement Targets Scoring Weightso Targets Scoring Weightso Measures to be Implementation of a To be determined by developed by quality improve- Government Task consensus review ment project Leader process CAHPS For QIOs electing to work on self management of medication therapy gSee Table A.3 for measures. hExtra credit for the Appropriate Care Measure Identified Participant Group is based on recruitment of hospitals.
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with the help of nursing homes at the statewide level Submit statewide targets for the measures of high-risk pressure ulcers and for physical restraints; submissions for measures of management of depressive symptoms and management of pain in chronic pain are optional Documentation of PARTner activity codes Documentation of baseline and annual remeasurement rates for resident satisfaction Documentation of baseline and annual remeasurement rates for staff satisfaction Documentation of annual certified nursing assistant or nursing aids turnover rate Quarterly submission of mandatory process of care data (optional) Task 1b: Home Health QIO training of home health agencies on Lists of the clinical performance of identified OBQI participant group and their plans of action List of identified participants Lists of the systems improvement and organization culture change identified participant group
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APPENDIX A 431 TABLE A.7 Continued 7th SOW Deliverables 8th SOW Deliverables List of contact information for each Selected statewide OASIS measure participant Acute care hospitalization strategic plan Acute care hospitalization strategic plan final report Systems improvement and organization culture change identified participant group survey results Systems improvement and organizational culture change identified participant group plans of action Statewide survey results of statewide immunization practices Documentation of PARTner activity codes Task 1c1: Hospitals List of contact information for every Update data on Provider Reporting System hospital in the state List of identified participants for acute care measure, surgical care improvement project, and systems improvement and organization culture change identified participant groups Documentation of contact with local American College of Surgeons president Results of baseline readiness/adoption tool for CPOE, bar coding, or telehealth Results of remeasurement readiness/adoption tool for CPOE, bar coding, or telehealth Systems improvement and organizational culture change hospitals' plans for CPOE, barcoding, and telehealth implementation plans Task 1c2: Critical Access Hospitals N/A Submission of critical access hospital measure set Report of quality improvement activities on at least one critical access hospital measure List of participants for identified participant group Final report of quality improvement activities with all reporting critical access hospitals continues
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432 APPENDIX A TABLE A.7 Continued 7th SOW Deliverables 8th SOW Deliverables Submission of the Rural Organizational Safety Culture Change interventions and change models tested/implemented Baseline results and methods of safety culture survey Report of Rural Organizational Safety Culture Change intervention and change models implemented Remeasurement results of safety culture survey Task 1d1: Physician Practice List including each identified participant Assistance given to Medicare Advantage along with his or her Unique Physician plans Identification Number via PARTner List of contact information for each Assistance provided to support Physician participating physician office Voluntary Reporting Program and other statewide work Recruitment plan Work plan indicating the technical assistance activities offered to identified participant physician practice sites, including those sites in Task 1d2 List of physician practices sites receiving QIO assistance Strategy and assistance for electronic submission of DOQ measures Office System Survey assessing status of identified participant group for electronic clinical information production and use Updated environmental scan List of physician practice sites with applications of interest for QIO assistance List of physician practice sites using EHR due to work of QIO Information depicting QIO efficiencies Office System Survey of identified participant groups Task 1d2: Physician Practice: Underserved Populations N/A Identify Task 1d1 underserved identified participants Identify CLAS identified participants Report efforts to reach underserved populations Report CLAS results
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APPENDIX A 433 TABLE A.7 Continued 7th SOW Deliverables 8th SOW Deliverables Task 1d3: Physician Practice/Pharmacy: Part D Prescription Drug Benefit N/A Assessment of environment for electronic prescribing and continuous quality improvement QIO staff/training plan Baseline levels of performance Submission of two concept papers for quality projects to be developed with Medicare Advantage and other prescription drug plans Submission of one project proposal for a quality project to be developed with Medicare Advantage and other prescription drug plans Plan interventions and develop interventional materials Identify annual quality measure targets Report required information on providers involved in projects Directory of contacts within each prescription drug plan Task 1e: Underserved and Rural Beneficiaries Submission of approved 6th SOW plans N/A targeting an underserved population Submission of plan if new project was chosen Report of final results Task 1f: Medicare Advantage Plan of action to invite Medicare+Choice N/A organizations to participate in Tasks 1a to 1e Submit list of contacts for all Medicare+ Choice organizations NOTE: SOW = scope of work; QIO = Quality Improvement Organization; PARTner = Program Activity Reporting Tool; OBQI = Outcome-Based Quality Improvement; OASIS = Outcomes and Assessment Information Set; CPOE = computerized provider order entry; N/A = not applicable; DOQ = Doctor's Office Quality; EHR = Electronic Health Record; CLAS = culturally and linguistically appropriate service.
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Key Terms
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