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Quality Innovation Networks – Notable Impact for Providers 

ESO Staff

The most recent report from the Centers for Medicare & Medicaid Services (CMS) shows that the federally funded Quality Improvement Organization (QIO) program achieved an impressive and far-reaching impact in a number of areas for both health care providers and Medicare beneficiaries.  

Divided into two parts – Quality Innovation Networks-QIQs (QIN-QIOs) and Beneficiary and Family Centered Care-QIOs (BFCC-QIOs) –  the QIO program works to improve health care quality at the community and individual level by increasing collaboration between providers across the nation, offering training and tools, and helping relieve the burden on providers so they can more efficiently focus on each patient. 

Every year, CMS must submit a progress report to Congress on the administration, cost, and impact of the QIO program. The 2017 QIO progress report included numerous successes and improvements in four key areas of focus, and also shared several statistics exhibiting the need for these efforts, including: 

Antibiotic Stewardship 

The provider-focused element of the QIOs worked to combat antibiotic resistant bacteria by increasing awareness of the importance of proper antibiotic use and supporting outpatient providers in their efforts to monitor, reduce, and prevent misuse and overuse of antibiotics. 

  • More than 7,6000 outpatient facilities have been involved in the effort to reduce antibiotic-resistant bacteria. 
  • 48.7% of the outpatient settings have implemented the CDC’s Core Elements of Outpatients Antibiotic Stewardship activities. 

 Behavioral Health 

Six regional QIN-QIOs provided technical assistance and educational interventions to help primary care providers screen for and identify people with alcohol use disorder and/or depression. In addition, the program helped inpatient psychiatric facilities improve transitions of care and reduce readmissions for these patients. 

  • More than 5,050 practices were recruited to increase the number of alcohol and depression screenings available. 
  • More than 306,600 alcohol screenings were conducted during primary care visits 
  • 837,800depression screenings were conducted during primary-care visits 

Medication Safety 

QIN-QIOs work to reduce or prevent adverse drug events via improvement processes and education on proper medication use and patient engagement. 

  • More than 7,450 facilities, clinicians, and practices were working with QIOs to boost medication safety and prevent adverse drug events 
  • More than 2.3 million beneficiaries marked as high risk were screen for potential adverse drug event. 
  • An estimated 15,600 severe adverse drug events were avoided in the Medicare high-risk population. 
  • More than 1.4 million medication-related adverse outcomes were identified for opportunities of harm avoidance. 

Nursing Home Care 

Participating in the National Nursing Home Quality Care Collaborative, QIN-QIOs helped provide participating nursing homes with training and tools to enhance performance and resident safety; improve antibiotic stewardship practices; and work with dementia care units to reduce unnecessary anti-psychotic medication use. 

  • There was a 26% reduction in anti-psychotic medication use among nursing homes across the nation. 
  • About 54,500 fewer nursing home patients received unnecessary anti-psychotic medications 
  • More than 12,200 nursing homes were recruited in efforts to reduce health care-acquired conditions and improve patient care 

Other key areas of focus with annual statistics were cardiac health, care coordination, diabetes care, immunizations, quality reporting and payment, and a Transforming Clinical Practice Initiative (TCPI). The report also highlighted several case studies of participating providers who saw success over 2017. 

CMS recently redesigned the structure of the QIO Program to maximize learning and collaboration in improving care, enhance flexibility, support the spread of effective new practices and models of care, in turn delivering added value to beneficiaries, patients, and taxpayers. Changes included separating case review from quality improvement, extending the contract period of performance, removing requirements to restrict QIO activity to a single entity in each state/territory, and opening contractor consideration to a broader range of entities. 

The QIO website includes a map tool to locate your nearest QIO, including the network that supports health care providers. Providers, stakeholders, and partners are encouraged to contact the local QIO to learn more about the QIO projects. By participating in a local QIN-QIO initiative, providers gain access to helpful resources, including evidence-based improvement strategies that are aligned with other major health quality initiatives and that can help prepare them for participation in the CMS Quality Payment Program. 

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