The Centers for Medicare & Medicaid Services (CMS) QIO Program has awarded 16 two-year Special Innovation Projects (SIPs) to 10 regional Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs).
With a combined value of just under $10 million, the SIPs are quality improvement projects that align with the goals of the CMS Quality Strategy and emphasize the power of partnerships. QIN-QIOs were eligible to submit proposals for two types of SIPs in FY 2015:
The first addresses issues of quality occurring within the QIN-QIOs’ local service area (“Innovations that Advance Local Efforts for Better Care at Lower Cost”); The second focuses on expanding the scope and national impact of quality improvement interventions that have had proven but limited success (“Interventions that are Ripe for Spread and Scalability”). For the second type of SIP, QIN-QIOs were encouraged to propose interventions intended to reduce mortality, harm, health care disparities and costs; provide higher return on investment; link value with quality; and encourage utilization of alternative payment models by providers.
CMS sought proposals with scientific rigor, a strong analytic framework and a reasonable, proposed intervention based on the supporting evidence provided. Additionally, CMS looked for evidence of QIN-QIO partnerships at the community, regional and national levels, and direct links to the CMS Quality Strategy goals, among other criteria.
Following are two tables showing the SIP awardees, proposal title and a brief project synopsis.
Innovations that Advance Local Efforts for Better Care at Lower Cost (SIP1)
|Atlantic||Transforming End of Life Care/Advanced Care Planning||The project will educate acute care hospitals, skilled nursing facilities and home health providers in select New York counties about Advance Care Planning/Medical Orders for Life-Sustaining Treatment policies and provide them with training for adoption and implementation.Planned outcome is increase in Electronic Medical Orders for Life-Sustaining Treatment (eMOLST) Registry in number of completed advanced directives and in number of health care organizations adopting and implementing eMOLST.|
|Great Plains||Colorectal Cancer Screening (CRC)||The project will work with primary care providers in Kansas, Nebraska, North Dakota and South Dakota to recommend screening to their patients and help create a systematic process that ensures recommendations and follow-ups for all patients. Planned outcome is increase in colorectal cancer screening rates.|
|Qualis Health||Standardization of Discharge Processes from Short-Stay Skilled Nursing Facilities to Impact 30-Day Readmissions||The project will use the Project Re-Engineered Discharge checklist & modify it to support discharges from short-stay skilled nursing facilities to the next setting of care in Washington State and Idaho. Planned outcome is improvement in index hospital and post-nursing home discharge 30-day readmit rates to reduce unnecessary re-hospitalizations.|
|Quality Insights||Palliative Care/Hospice Referrals for Heart Failure Patients||The project will use the learning and action network model to develop interdisciplinary, multi-setting palliative care teams serving patients in Delaware, Louisiana and West Virginia who have heart failure in serious or terminal disease stages in order to manage their symptoms; coordinate care across settings; clarify communications; carry out self-directed end-of-life care decisions; and educate clinicians about advance care planning. Planned outcome is increase of patients with heart failure receiving palliative care within six to 12 months of death.|
|Telligen||Readmission Reduction in Rural Hospitals of Colorado||The project will adapt the C-TraC model (a telephonic, protocol-driven program designed to reduce 30-day readmissions and improve care transitions) for use by rural hospitals in Colorado. Planned outcome is reduction of 30-day readmissions and improvement of days at home; and monitoring of rates of ambulatory-sensitive readmissions.|
|TMF||Medication Adherence||The project will use education campaigns (patient/physician/pharmacist) to improve medication adherence for diabetes, hypertension and cholesterol medications in six municipalities of Puerto Rico. They also will provide technical assistance to increase e-prescribing in a select group of recruited physicians. Planned outcome is improvement in Medicare Part D Claims for Medication Adherence (diabetes medications, hypertension and cholesterol) and physician use of e-prescribing.|
|VHQC||Stopping Sepsis in Long-Term Care||The project will help reduce sepsis in skilled nursing facilities in Maryland with high rates of infection. The intervention will be based on the long-term care sepsis screening tool developed by the Minnesota Hospital Association. Planned outcome is improvement in the proportion of hospitalizations resulting from sepsis; and in the proportion of residents with sepsis who are hospitalized for treatment.|
Interventions Ripe for Spread and Scalability (SIP2)
|Atlantic||Community-Based Sepsis Initiative||The project will use Guidelines for Management of Severe Sepsis and Septic Shock, and Surviving Sepsis campaign materials to educate public and pre-hospital and hospital providers in New York and South Carolina about how to recognize the signs and symptoms of sepsis. Planned outcome is improvement in admissions, mortality and lengths of stay by category of sepsis, severe sepsis and septic shock, as well as 30-, 60- and 180-day readmissions for principal diagnosis of sepsis.|
|HealthInsight||Expanding Participation in Chronic Disease Self-Management Education Programs||The project will build on the existing infrastructure of Community Self-Management Education Programs in Oregon to increase integration and access by patients with chronic diseases. Planned outcome is improvement in HbA1c, high blood pressure control and improvement in the percent of clinics with a policy to document self-management goals for persons with high blood pressure, diabetes, or pre-diabetes. They also are seeking improvement in the number of Coordinated Care Organizations with policy to refer persons with diabetes to the Stanford self-management programs; the percent of participants in Stanford self-management programs referred by a health care provider; and finally the percent of Oregonians with diabetes who graduate from a Chronic Disease Self-Management Program in the pilot sites.|
|Health Services Advisory Group||Hand Hygiene/Safe Injections in Ambulatory Surgical Centers||The project will reduce healthcare-associated infections in ambulatory surgery centers in select California counties, The project will develop a learning and action network to promote adoption and spread of evidence-based best practices for safe hand hygiene and safe injection practices. Planned outcome is improvement in Medicare claims for postsurgical acute care visits following ambulatory surgery.|
|Mountain-Pacific Quality Health Foundation||ReSourcing for Super-utilizers in a Rural Setting: An Application of Hot Spotting Philosophies||The project will translate the “Camden Coalition of Healthcare Providers” model from an urban to a rural setting in Montana with the intent of reducing high rates of emergency department and hospital use by patients with complex care needs. Planned outcome is improvement in inpatient admissions and emergency departments visits within six months post-intervention against a control group; also patient satisfaction as measured with the Patient Satisfaction Questionnaire Short Form.|
|Qualis Health||Extend "Choosing Wisely" in Washington State to Help Physicians and Patients Engage in Evidence-Based Practices Around the Best Options for Specialty Tests||The project will implement the “Choosing Wisely” campaign in Washington State, which provides actionable feedback to providers, consumers and payers on low-value health services, directing attention to those measures, counties and insured populations that show the greatest opportunity for improvement. Planned outcome is a reduced percentage of patients with qualifying conditions that receive low-value services among fee-for-service Medicare beneficiaries in Washington at the state level for each of twelve (12) Choosing Wisely metrics. Also, the number of counties in Washington that improve from baseline in the percentage of patients with qualifying conditions that receive low-value services among fee-for-service Medicare beneficiaries for each of the twelve (12) metrics.|
|Quality Insights||Quality Improvement in Long-Term Acute Care Hospitals||The project will engage long-term acute care hospitals (LACHs) in quality improvement activities related to healthcare-associated infection prevention, using root cause analysis and evidence-based intervention strategies related to hand hygiene, isolation precautions and ventilator-associated pneumonia. The intervention will initially target LACHs in Louisiana and spread to Delaware, New Jersey, Pennsylvania and West Virginia. Planned outcome is 25% relative improvement in Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infections, Clostridium difficile Infection, Methicillin-resistant Staphylococcus aureus, and Ventilator-Associated Event Standardized Infection Ratios in Long-Term Care Hospitals.|
|Telligen||Nursing Home Quality Improvement Certificate of Completion||The project will develop a Nursing Home Quality Improvement Certificate of Completion in coordination with the National Association for Healthcare Quality to award to nursing home staff that complete the equivalent of a two-day training program with pre- and post-tests and a knowledge-based skills test. The project will target nursing homes with poor staff retention rates in Iowa and Illinois.Planned outcome will compare outcomes on quality metric versus control homes. They will complete follow-up surveys with administrators about staff and with staff that were trained.|
|TMF||Improve Early Detection and Management of Sepsis||The project will work with 10 hospitals in two Texas communities to help promote an early detection screening tool to identify Systemic Inflammatory Response Syndrome and to promote timely implementation of evidence-based sepsis bundles. Planned outcome is improvement in fee-for-service (FFS) inpatient claims for severe sepsis or septic shock per 1,000 FFS Medicare beneficiaries and per inpatient stay. Also, as a process measure, the project looks for improvement in the percent of recruited hospitals implementing a screening tool, percent of recruited hospitals implementing three-hour sepsis bundles, and percent of recruited hospitals implementing six-hour sepsis bundles.|
|VHQC||Advanced Care Management in the Accountable Care Organization Setting||The project will implement the Advanced Care Model with providers and Medicare beneficiaries in a large health system in Virginia in order to improve patient engagement and promote the delivery of end-of-life care more consistently with individual preferences and values. Planned outcome is assessing the hospital admissions in the last six months of life; the hospital days in the last six months of life; intensive care unit days in the last six months of life; the total health care costs in the last six months of life; percent of enrollees with advanced directives; the percent of enrollees with physician orders for life-sustaining treatment; and the percent of patients with care goals and preferences documented in electronic medical records that are updated monthly|