Improve the Health Care System

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Working Together to Combat Antibiotic Resistant Bacteria through Antibiotic Stewardship in Communities

The development of antibiotics revolutionized the field of medicine. But their broad use in clinical practice is causing bacteria to develop resistance, which makes antibiotics less effective. This is a threat not only to individuals but also to public health. As a result, QIN-QIOs are helping providers implement antibiotic stewardship programs in settings that include physician practices, pharmacies, emergency departments, public health clinics, urgent care clinics, Federally Qualified Health Centers and ambulatory surgery centers.

In addition to increasing awareness of the importance of proper antibiotic use, QIN-QIOs are delivering technical assistance that builds the capacity of outpatient providers to: 1) make policy and process changes required to implement effective antibiotic stewardship programs; 2) identify and measure current antibiotic use that is not for the treatment of bacterial infections; 3) target antibiotics more specifically to different types of infections; 4) educate patients and offer them alternatives to antibiotics; and 5) measure changes in antibiotic use rates after implementing a stewardship program to assess its results. QIN-QIOs are also helping carry out the recommendations of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria by forming, leading and/or participating in related partnerships with state and local agencies, private-sector organizations, patient advocacy groups, and other entities. 

Reducing Health Care-Acquired Conditions in Nursing Homes

More than three million Americans rely on services provided by nursing homes at some point during the year. About 1.4 million Americans reside in the nation’s 15,600 nursing homes on any given day. Those individualsand an even larger number of their family members, friends, and relativesmust be able to count on nursing homes to provide reliable, high-quality care. In recent years, CMS developed a strategy that will guide local, state, and national efforts to improve the quality of care in nursing homes. The most effective approach to ensure quality is one that mobilizes and integrates all available tools and resourcesaligning them in a comprehensive, actionable strategy that nursing homes can adopt and sustain.

Through the National Nursing Home Quality Improvement Campaign, QIN-QIOs support this kind of system-wide improvement, which helps eliminate health care-acquired conditions (HACs) like pressure ulcers and falls, and can dramatically improve resident satisfaction. Thousands of facilities across the country have participated in the Campaign since 2012, and many are continuing their participation. Others are invited to join, especially those that attained a one-star rating in CMS’ Nursing Home Compare program, indicating they have room for improvement on multiple dimensions of resident care and safety. QIN-QIOs lead the regional and community levels of the Campaign, which provides training and tools based on the best clinical, management, and leadership practices of high-performing nursing homes. Topics include increasing mobility among long-stay residents, decreasing unnecessary use of antipsychotics for residents with dementia, preventing potentially avoidable hospitalizations, and decreasing health care-acquired infections and other HACs. QIN-QIOs supplement Campaign activities with focused technical assistance to help facilities implement what they have learned.

Promoting Effective Care Coordination and Communication

Both the National and CMS Quality Strategies recognize the importance of coordinating clinical decisions and improving communication among providers. The QIO Program has made great strides in helping providers and communities reduce avoidable readmissions and improve transitions of care (at about $1 billion in cost savings from 2011 to 2014). QIN-QIOs are uniquely positioned to spark and strengthen community-based care coordination initiatives through their experience in building coalitions of acute and post-acute providers, practitioners, long-term care services and supports, patients and their advocates, and other local stakeholders.

As the Program amplifies and extends its assistance for care coordination, QIN-QIOs continue to play an essential role, facilitating the formation of new coalitions and encouraging all collaborative groups to focus on improving the quality of care. Program emphasis is placed on serving Medicare beneficiaries with multiple chronic conditions, with health literacy needs or those living in rural areasspecifically, beneficiaries who will benefit the most from the transformation of our fragmented health care system into one in which coordinated care is the norm.

Improving Medication Safety

Adverse drug events (ADEs) contribute to significant patient harm and may trigger unnecessary diagnostic tests and avoidable hospital admissions and readmissions. From August 2014 through January 2017, QIO Program efforts to improve medication safety have resulted in:

  • Screening more than 1.2 million Medicare beneficiaries at high risk for ADEs
  • Identifying more than 662,750 opportunities of harm avoidance related to medication use (potential ADEs*)
  • Working with 3,700+ families, clinicians and practices on improving medication safety and preventing ADEs

QIO Program medication safety work is in direct support of the HHS National Action Plan for ADE Prevention and spans the continuum of care in every state. QIN-QIOs work with pharmacies, nursing homes, primary care, and outpatient facilities to improve medication safety, as well as communication and coordination related to medication management. Through data-driven, systems-level quality improvement initiatives, QIN-QIOs make health care improvements for the high-risk Medicare population, including Medicare beneficiaries who are taking multiple medications and an opioid, anticoagulant, or diabetic medication.

*Potential ADEs (pADEs) are reported by QIN-QIOs quarterly, and an individual Medicare beneficiary may have multiple pADEs per quarter.