2014 QIO report shows encouraging results on adverse drug events, cost savings

Quality Improvement Organizations (QIOs) generated nearly $1 billion in savings and prevented more than 44,000 adverse drug events over a three-year period, according to a Centers for Medicare & Medicaid Services' progress report.

The QIOs also noted 85,149 fewer days with urinary catheters for Medicare beneficiaries between 2011 and 2014.

CMS announced it would restructure the program last May, hiring two contractors to review and monitor activities and awarding contracts to organizations that work on care improvement directly with providers. The new structure features two types of QIOs; the first, Quality Innovation Network (QIN-QIOs) is divided into 14 regional organizations that collaborate with community partners, providers and beneficiaries on patient safety, harm reduction and patient engagement initiatives. The second features two Beneficiary and Family Centered Care (BFCC) QIOs that address complaints and appeals from all beneficiaries throughout the nation. 

The new structure maintains separate spheres for the program's regulatory framework and its quality improvement initiatives, streamlining both sectors' work. Improved care transitions under QIOs saved providers nearly $1 billion from 2011 to 2014, according to a report from the American Health Quality Association.

Health and Human Services Secretary Sylvia Mathews Burwell in a December 2014 address credited the QIO program for helping to achieve a 17 percent drop in overall harm, or 1.3 million fewer harms and $12 billion in savings, Dennis Wagner, acting director of CMS' Center for Clinical Standards and Quality, Quality Improvement Group, said in a video introduction to the report.

"QIOs are uniquely positioned to lead the integration of American healthcare across provider types, from physician practices to hospitals to long-term to home health," Wagner said. "Patients need providers and provider organizations that work and talk and team together at the community level." 

One of the QIO program's major successes in 2014 was the partnership between Qualis Health Quality Innovation Network, the QIN-QIO serving the Idaho/Washington region, and the Washington State Hospital Association (WSHA). Through the partnership, the two organizations address concerns such as preventable readmissions and hospital-acquired infections (HAIs).

The QIO conducts monthly leadership and team meetings, shares calendars for educational events and participates in one another's webinars. Under the partnership, Washington has reduced readmissions (the report notes a 27 percent relative improvement rate per 1,000 Medicare beneficiaries over a three-year period) with the two organizations planning similar initiatives devoted to antimicrobial stewardship and infection prevention.

Another highlight of 2014 was a pilot program by the Centers for Disease Control and Prevention (CDC) and seven QIOs to reduce catheter-associated urinary tract infections through the CDC's Targeted Assessment for Prevention strategy. The success of the pilot has led the CDC to expand its QIO partnership to all QIN-QIOs.

Over the next five years, the program aims to collaborate with providers on evidence-based stroke and heart attack prevention best practices, with particular emphasis on disproportionately affected racial demographics such as African-Americans, Asian-Americans and Pacific Islanders. The program also plans to more aggressively target HAIs through collaborations with partners such as the Agency for Healthcare Research Quality's Comprehensive Unit-Based Safety Program.

To learn more:
- here's the report