From Adversary to Partner: Have Quality Improvement Organizations Made the Transition?

Abstract

Objective. To describe the perceived impact of the Centers for Medicare and Medicaid Services Quality Improvement Organizations (QIOs) on quality of care for patients hospitalized with acute myocardial infarction, in the context of new efforts to work more collaboratively with hospitals in the pursuit of quality improvement. Data Source. Primary data collected from a national random sample of 105 hospital quality management directors interviewed between January and July 2002. Study Design. We interviewed quality management directors concerning their interactions with the QIO interventions, the helpfulness of QIO interventions and the degree to which they helped or hindered their hospital quality efforts, and their recommendations for improving QIO effectiveness. Principle Findings. More than 90% of hospitals reported that their QIO had initiated specific interventions, the most common being the provision of educational materials, benchmark data, and hospital performance data. Many respondents (60%) rated most QIO interventions as helpful or very helpful, although only one-quarter of respondents believed quality of care would have been worse without the QIO interventions. To increase QIO efficacy, respondents recommended that QIOs appeal more directly to senior administration, target physicians (not just hospital employees), and enhance the perceived validity and timeliness of data used in quality indicators. Conclusions. Our study demonstrates that the QIOs have overcome, to some degree, the previously adversarial and punitive roles of Peer Review Organizations with hospitals. The generally positive view among most hospital quality improvement directors concerning the QIO interventions suggests that QIOs are potentially poised to take a leading role in promoting quality of care. However, the full potential of QIOs will likely not be realized until QIOs are able to engender greater engagement from senior hospital administration and physicians.

Sexual Self Schema as a Moderator of Sexual and Psychological Outcomes for Gynecologic Cancer Survivors

“…This was expected, as health worries are the source of greatest concern among survivors (Spencer et al, 1999) and health impairments impact patients' return to normal routines (Bradley et al, 2005), and even the meaning patients derive following the cancer experience (Jim & Andersen, 2007). The variables contributed significant variance-5 to 25% across the sexual outcomes and 23 to 40% across the psychological outcomes.…”

Quality Improvement

“…We monitor that, but there are things that the hospital can't control" (p 471). 78 Similarly, managers believed that senior administrative engagement was crucial: "I think they need to work more with upper administration. My biggest struggle was I didn't have really good physician buy-in.…”

“…Bradley and colleagues 78 performed a national survey of 105 hospital quality management directors to evaluate their views on quality improvement organizations for their impact on the quality of care for patients hospitalized with acute myocardial infarction. A major recommendation from surveyed staff about how quality improvement organizations could be more effective was to enhance engagement with physicians and senior management.…”

“…So if they could do better with hitting the chief executive officers on how important this is, it could trickle down and do better" (p 472). 78 Strategies to Address the Gap 1. Develop models for partnership and shared accountability between physicians and managers with an overall goal for both effectiveness and efficiency of patient care.…”

A Statewide Collaborative Initiative to Improve the Quality of Care for Patients With Acute Myocardial Infarction and Heart Failure

“…[12][13][14][15] Critics have noted that QIOs vary in how effectively they engage participating hospitals. 14 Furthermore, QIOs typically work with administrative staff and may have insufficient direct contact with front-line providers.…”