Assessment of the Medicare Quality Improvement Organization program

Background: Studies have shown improvement in quality of health care in the United States. However, the factors responsible for this improvement are largely unknown. Objective: To evaluate the effect of the Medicare Quality Improvement Organization (QIO) Program in 4 clinical settings by using performance data for 41 quality measures during the 7th Scope of Work. Design: Observational study in which differences in quality measures were compared between baseline and remeasurement periods for providers that received different levels of QIO interventions. Setting: Nursing homes, home health agencies, hospitals, and physician offices in the 50 U.S. states, the District of Columbia, and 2 U.S. territories. Participants: Providers receiving focused QIO assistance related to quality measures and providers receiving general informational assistance from QIOs. Measurements: 5 nursing home quality measures, 11 home health measures, 21 hospital measures, and 4 physician office measures. Results: For nursing home, home health, and physician office measures, providers recruited specifically by QIOs for receipt of assistance showed greater improvement in performance on 18 of 20 measures than did providers who were not recruited; similar improvement was seen on the other 2 measures. Nursing homes and home health agencies improved more in all measures on which they chose to work with the QIO than in other measures. Nineteen of 21 hospital measures showed improvement; in this setting, QIOs were contracted for improvement initiatives solely at the statewide level. Overall, improvement was seen in 34 of 41 measures from baseline to remeasurement in the 7th Scope of Work. Limitations: As in any observational study, selection bias, regression to the mean, and secular trends may have influenced the results. Conclusions: These findings are consistent with an impact of the QIO Program and QIO technical assistance on the observed improvement. Future evaluations of the QIO Program will attempt to better address the limitations of the design of this study.