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Quality improvement organizations

Posted on:3/24/2006
Quality Improvement Organizations (QIOs) monitor the appropriateness, effectiveness, and quality of care provided to Medicare beneficiaries.

Quality Improvement Organizations (QIOs) monitor the appropriateness, effectiveness, and quality of care provided to Medicare beneficiaries. They are private contractor extensions of the federal government that work under the auspices of the U.S. Centers for Medicare and Medicaid Services (CMS).


In recent years QIOs have undertaken to facilitate continual improvement of health care services within their constituent communities in addition to their original and ongoing statutory audit/inspection role of medical peer review, i.e., akin to the traditional function of quality assurance. This shift in emphasis began in the mid-1990s and has accelerated into the 21st century. Originally known as PROs (Peer Review Organizations), their name was officially changed to QIOs as per the Federal Register on May 24, 2002 in large part to reflect this new emphasis on population-based quality improvement. CMS contracts with QIOs in three year cycles, referred to as "Scopes of Work" (SOWs). QIOs are staggered into three categories (round 1, round 2, and round 3) - each of these three groups start their contract cycle at slightly different times (usually offset by several months). QIOs are currently in their Eighth SOW, which started in August, 2005 (for round 1 QIOs) and introduced the theme of "transformational change" to be achieved through accelerating the rate of quality improvement, raising the bar for performance, and facilitating profound cultural change by incorporating Health Information Technologies.


An example of current QIO quality improvement work is that of the federal Doctor's Office Quality Information Technology initiative, which:


promotes the adoption of electronic health record systems and information technology in small-to-medium sized physician offices with a vision of enhancing access to patient information, decision support, and reference data, as well as improving patient-clinician communications.

Another example is:


national coordination and support of the Surgical Care Improvement Project (SCIP), a hospital based quality improvement initiative led by CMS that focuses on reducing the rate of adverse outcomes of common surgical procedures. This is an effort endorsed by the Centers for Disease Control (CDC), the American College of Surgeons (ACS), the American Hospital Association (AHA), and a large number of professional societies that include physicians, pharmacists, nurses, anesthesiologists, and others. It is estimated that adoption of all the "bundles" of suggested care in the areas of surgical site infection, cardiovascular care, venous thromboembolism prevention, and pulmonary care, could reduce the rate of surgical morbidity and mortality by 25% by the year 2010.

QIOs also help coordinate and facilitate the timely submission of data for public reporting of institution-specific quality measure performance information that is available on CMS websites such as "Nursing Home Compare" and "Hospital Compare".


In recent years, QIO hospital work has tended to reinforce and complement that of the Institute for Healthcare Improvement (based in Boston, MA).


The QIOs are represented nationally by the American Health Quality Association.



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