Quality of care not necessarily better in hospitals that participate in quality improvement program

June 14, 2005

Hospitals that participate with the quality improvement organization (QIO) program are not more likely to show improvement on quality indicators than hospitals that do not participate, according to a study in the June 15 issue of JAMA.

According to background information in the article, "Since its inception in 1965, the Medicare program has been concerned that Medicare beneficiaries receive appropriate and efficiently provided medical care." The authors explain: "Medicare currently contracts with quality improvement organizations (QIOs) and allocates approximately $200 million annually for quality improvement. Quality improvement organizations work with hospitals on quality improvement in a variety of ways, including providing educational materials, using data collection and feedback to track performance on quality indicators, and assisting hospitals in implementing systems changes (e.g., standing orders, clinical pathways.) In dollar terms, the QIOs are the federal government's largest initiative for improving the quality of care."

Claire Snyder, Ph.D., and Gerard Anderson, Ph.D., from The Johns Hopkins Bloomberg School of Public Health, Baltimore, reviewed data from four QIOs charged with improving the quality of care in five states (Maryland, Nevada, New York, Utah, and Washington) and the District of Columbia. A retrospective study was conducted comparing improvement in the quality of care of patients in hospitals that actively participated with the QIOs versus the hospitals that did not participate. The researchers analyzed data from the medical records of approximately 750 Medicare beneficiaries per state in each of five clinical areas: atrial fibrillation, acute myocardial infarction, heart failure, pneumonia, and stroke. The researchers looked at 15 quality indicators associated with improvement outcomes in the prevention or treatment of those five clinical areas at the study's baseline (1998) and again in 2000 - 2001 as a follow-up.

"At baseline, there were statistically significant differences between participating and nonparticipating hospitals on 5 of 15 quality indicators, with participating hospitals performing better on 3 of 5," the authors found. "There was no statistically significant difference in change from baseline to follow-up between participating and nonparticipating hospitals on 14 of 15 quality indicators. The one exception was that participating hospitals improved more on the pneumonia immunization indicator than nonparticipating hospitals," the authors note.

"The IOM (Institute of Medicine) is currently evaluating the QIO program, including operations, program evaluations, and whether other entities could perform the QIOs' functions. The findings from this study do not support the hypothesis that the QIO program improves the quality of care for Medicare beneficiaries in the inpatient setting," the authors write. "Additional efforts to assess and improve the QIOs effectiveness may be needed. The current IOM assessment of the QIO program provides an opportunity to evaluate the program further and recommend program modifications as needed," the authors conclude.
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(JAMA. 2005; 293:2900 - 2907. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This project was supported by grants from the Agency for Healthcare Research and Quality.

The JAMA Network Journals

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