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

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.

Contact: Tim Parsons
JAMA and Archives Journals

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