QIO Impact: Making a Quality Difference in California Healthcare
Better healthcare is about making an impact and saving lives. The national Quality Improvement Organization (QIO) program is more important than ever as healthcare is increasingly provided to an aging population with multiple, chronic diseases. As California’s QIO from November 2005 – October 2008, Lumetra is proud to have successfully partnered with you in measurably improving healthcare across the state.
Within the 8th Scope of Work (8SOW), from November 2005 to October 2008, QIOs addressed more than 40 clinical and electronic health system quality measures affecting quality of care in nursing homes, home health agencies, hospitals, and physician offices. In California alone, with more than 4.4 million Medicare beneficiaries, at least 80% of beneficiaries received better quality of care as measured by improvement in one or more quality indicators in these healthcare settings.
Medical Review
Lumetra conducted almost 30,000 medical case reviews from November 2005 through September 2008. These included reviews related to:
- Beneficiary complaints
- Appeals
- Emergency Medical Treatment and Active Labor Act (EMTALA)
- Hospital Payment Monitoring Program (HPMP)
- Referrals
Hospitals
Lumetra partnered with hospitals throughout California to improve systems of care, with a specific focus on evidence-based measures of quality. Using a collaborative model, we worked with 36 hospitals to improve performance on the Appropriate Care Measures (ACM). As of First Quarter 2007 discharges, 86% of the participating hospitals had achieved the CMS goal of closing the gap between baseline measurement and 100% for the ACM measure by at least 25%.
We also formed a collaborative set of hospitals to increase process measures for the Surgical Care Improvement Project (SCIP). SCIP’s mission was to reduce infection in surgical patients via evidence-based preventive measures. Overall, the participant hospitals improved the number of their patients who received the appropriate preventive antibiotic treatment in a timely manner by 5.3%.
Finally, we teamed with hospitals to improve patient safety. Half of the participants showed significant improvement between baseline and remeasurement.
Medication Safety Study
Lumetra conducted a collaborative study with six California health plans involving potentially inappropriate medications (PIM) in the elderly and clinically significant drug-drug interactions (DDI). The study quantified and profiled the prevalence of PIMs and DDIs among 368,607 Medicare members and made the following conclusions:
- The more medications the beneficiaries received, the higher the PIM and DDI prevalence.
- Beneficiaries with more than one prescriber are more than twice as likely to incur a DDI, and nearly 1.5 times more likely to receive a PIM than beneficiaries with a single prescriber.
- Interventions raised awareness of medication safety and improved communication between physicians, patients, and health plans.
Nursing Homes
As baby boomers enter their senior years, the need for quality nursing home care is more vital than ever. We worked with nursing homes across California to help them improve quality of care on specific measures: use of restraints, rate of pressure ulcers, and management of chronic pain.
California nursing homes that worked with our Person Centered Care Collaborative showed considerable improvement compared with homes not involved in the collaborative. For example, homes that worked with the collaborative, from Fourth Quarter 2005 to Third Quarter 2007, were able to reduce pressure ulcers by more than 7% compared to a statewide improvement of 1%.
Home Health Care
To support the national Home Health Quality Initiative, we joined with agencies statewide to improve patients’ breathing and avoid unnecessary rehospitalizations.
Working directly with the agencies to reduce hospitalizations and improve patient outcomes, our outreach efforts included 65 teleconferences, 26 workshops on process improvement, and other individualized technical support to over 300 agencies.
The results of these efforts yielded:
- A rehospitalization rate in California (23%) substantially below the nationwide rate (28%).
- Breathing improved for 63% of patients, a 4% increase over 28 months.
Physician Offices
Lumetra worked closely with primary care physicians to improve preventive and chronic care, and increase cultural competence. We also provided expert assistance on the selection, implementation, and ongoing use of electronic health record (EHR) systems.
We partnered with more than 1,000 primary care physicians in 266 practices in California from 2005 to 2008 to assist with the redesign of their office systems and care delivery. Throughout the 8SOW, we assisted over 23% of participating practices (67 of the 266 practice total) in the implementation of an EHR system.
Much to Be Done
As the 8SOW draws to a close, we can take a moment to celebrate. At the same time, we know there is much left to be done. Lumetra looks forward to partnering with you again in the future as we work with public agencies and commercial clients to positively impact the quality, safety, efficiency, and integrity of healthcare.
