Quality directors give QIOs high marks in new study

Majority say they find the organizations helpful’

Quality improvement organizations (QIOs) have gone a long way toward erasing "the previously adversarial and punitive roles" of their predecessors, the peer review organizations, according to a new study in the bimonthly journal Health Services Research.1

Researchers conducted interviews in 2002 with 100 directors of quality management from a randomly selected cross-section of all acute-care hospitals operating in 2001. More than 90% of the hospitals reported QIOs had initiated specific interventions, most commonly providing educational materials, benchmark data, and hospital performance data. The majority of respondents, 60%, rated QIO interventions as "helpful" or "very helpful."

"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," the authors wrote. They recommended QIOs "find ways to integrate physicians and hospital senior management more fully into QIO quality improvement initiatives."1

Under the direction of the Centers for Medicare & Medicaid Services (CMS), the QIO program consists of a national network of 53 QIOs responsible for each U.S. state, territory, and the District of Columbia.

QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among underserved populations.

Each QIO is led by a CEO with a health care background, explains David G. Schulke, executive vice president of The American Health Quality Association (AHQA) in Washington, DC. The rest of the organization includes health care professionals such as physicians, nurses, biostatisticians, and epidemiologists.

The Health Services Research study is not the only evidence QIOs are being perceived in a positive light, Schulke says.

"CMS, in its current contract period, hired an outside consulting firm to get on the phone and ask providers if QIOs had been helpful, and if they had been satisfied," he adds.

"This research was paid for out of the QIO budget, as part of their charge is to evaluate their performance," Schulke says. "People who work closely with QIOs" expressed satisfaction "way above 90%."

According to the AHQA, the positive responses break down as follows:

  • home health agencies — 95%;
  • hospitals — 92%;
  • managed care organizations — 94%;
  • nursing homes — 93%;
  • physician offices — 89%.

Why do QIOs engender such positive responses? For one thing, since 2002, most QIOs have conducted intensive collaboratives that bring together teams of hospital staff to prevent surgical infections and improve care for chronic conditions such as diabetes.

Beginning in the fall of 2002, CMS contracted with QIOs to help nursing homes and home health agencies measure and improve the quality of their services.

A QIO also might initiate a meeting with a specific facility, Schulke says.

"They may contact them, ask for a meeting, and tell them, for example, that they have new information to improve heart attack care that they would like to share. Or they may seek to find out what the hospital quality manager needs and see if they can provide it," he explains.

QIOs draw on the current literature, as well as on their experience with other hospitals and training from other areas, Schulke continues.

"They do their best to stay up to speed on the best strategies for improving quality, which they may learn at meetings such as those hosted by IHI [The Boston-based Institute for Healthcare improvement], or from other hospitals at collaboratives they have hosted, he notes.

Schulke says he was especially pleased to see the study’s authors recommend that QIOs find ways to integrate physicians and hospital senior management more fully, because in fact, he says, that is something QIOs already are doing.

"In the three years since the study survey was conducted, QIOs have increasingly engaged physicians and hospital executives in the quality improvement process, just as the authors of this study have advised," Schulke adds.

He recognizes the importance of this effort. "QI staff truly appreciated and got value from QIOs who helped them with physicians," he asserts.

"In working with physicians, often what the QIO needs to do is show them the literature in summary fashion. Also, the physicians need to see the data to really believe there is an issue for them to work on," Schulke notes.

For example, he says, a physician may have been trained years ago and may not know that the literature currently says you should use a clipper rather than a razor to trim hair if you wish to minimize infections — or not remove the hair at all.

"A doctor might be reluctant to believe that if told by hospital staff, but if you hear it from the experts, or the QIO can bring in literature, that will give them the confidence that this is a proven concept and can lower the risk to the patient," Schulke observes.


  1. Bradley EH, Carlson MDA, Gallo WT, et al. From adversary to partner: Have quality improvement organizations made the transition? Health Serv Res 2005; 40(2):459-476.