CMS Awards Special Innovation Projects to Quality Innovation Network-Quality Improvement Organizations Aimed to Drive Better Care, Smarter Spending, and Healthier People

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 (SIP 1)

QIN-QIO Title Synopsis

Alliant Quality

Improve Quality of Life for Skilled Nursing Facility Residents who are at the End of Life

Improve quality of life and satisfaction with end-of-life care of residents of skilled nursing facilities (SNFs) and reduce unnecessary acute care transfers in select areas of North Carolina and Georgia.

Expected outcome: Appropriate use of palliative care, improvement in resident and family satisfaction, reduction in avoidable acute care transfers, admissions and readmissions.

atom Alliance

Nursing Home Immediate Jeopardy Reduction

Utilize state supplied survey data and nursing home quality metrics to provide technical assistance to nursing homes in Kentucky and Mississippi that have received immediate jeopardy citations within the past three years.

Expected outcome: Reduction of immediate jeopardy citations, improvement in healthcare quality metrics, and shifting the focus of nursing homes on providing higher quality care.

Great Plains Quality Innovation Network

Home Health Infection Prevention and Management

Adapt and/​or create infection prevention and management resources that serve home health care agencies in Kansas, Nebraska, North Dakota and South Dakota. Successful interventions will be spread nationally through the Home Health Quality Improvement (HHQI) National Campaign.

Expected outcome: Reduction in acute care hospitalizations, respiratory infections, urinary tract infections and wound infections.

Health Services Advisory Group

Tele (Telepsychiatry) Infrastructure to Improve Access to Specialty Behavioral Health Services

Support and build capacity for behavioral health treatment in the Virgin Islands, using telepsychiatry.

Expected outcome: Reduction in the number of behavioral health admissions per 1,000 beneficiaries, reduction in emergency department visits per 1,000 beneficiaries, increased percentage of days spent at home.

Mountain Pacific Quality Health Foundation

Advance Care Planning

Utilize the Institute for Healthcare Improvement (IHI) Conversation Project Starter Kit and the Hawaii State Advance Care Planning and/​or Physician Orders for Life Sustaining Treatment (POLST) to improve advance care planning for Medicare beneficiaries in Hawaii.

Expected outcome: Improve advance care planning for 500 Medicare beneficiaries across 25 primary care providers and specialists. Improvement in physician process and level of comfort in discussing advanced care planning.

Qualis Health

Reducing Risk of Surgical Site Infections in Ambulatory Surgical Centers: Utilizing the EQuIP Model

Implement the Proactive Risk Assessment of surgical site infections in a select group of ambulatory surgery centers in Idaho and Washington utilizing the EQuIP Model.

Expected outcome: Reduce surgical site infections, improve self-assessed competency of infection prevention skills by participants, and observed improvement in infection prevention program structures and practices during onsite assessments.

Quality Insights Quality Innovation Network

Reducing Opioid Misuse and Diversion

Provide education on prescribing guidelines and encourage use of state prescription drug monitoring programs in Delaware, Louisiana, New Jersey, Pennsylvania and West Virginia. Engage patients and families, provide continued education for health care professionals, and convene state-level stakeholders and monitoring prescribing patterns to guide interventions.

Expected outcome: Reduction of opioid misuse on a statewide level (Delaware, Louisiana, New Jersey, Pennsylvania and West Virginia).

TMF Quality Innovation Network

Improve Treatment of Depression and Alcohol use Disorder in Primary Care Practices using the Project ECHO and Mental Health Integration Collaborative Models

Increase primary care physician knowledge of treatment for depression and alcohol use disorder utilizing Project ECHO and the Mental Health Integration Collaboration Models. To be piloted in 80 practices in Arkansas, Missouri, Oklahoma and Texas.

Expected outcome: Increase in treatment for patients who screen positive for depression/​alcohol use disorder by their primary care physician, percent of recruited practices that rate themselves highly regarding their competence in treating patients with depression and/​or alcohol use disorder.

Health Quality Innovators

Stopping Sepsis in Virginia Hospitals and Nursing Homes

Implement interventions focused on early identification and treatment of sepsis in 25 Virginia nursing homes and hospitals with the highest mortality and hospital transfer rates resulting from sepsis utilizing the Surviving Sepsis Campaign toolkits.

Expected outcome: Relative improvement rates of sepsis in hospitals and nursing homes. Reduction in hospital mortality and hospital admissions from nursing homes for sepsis.

Interventions Ready for Spread and Scalability (SIP 2)

QIN-QIO Title Synopsis

Alliant Quality

Eliminating Suffering of Sickle Cell Disease Patients

Working with 30 hospitals in North Carolina and Georgia, improve the triage, treatment and quality of care received in the emergency department for sickle cell disease (SCD) patients presenting with vaso-oclusive crisis (VOC).

Expected outcome: Increase in the number of patients with SCD presenting with pain to ESI Level 2; shortened time to first dose of pain medication; decreased admissions rates for patients with SCD; decreased 3-day return to the emergency department and decreased 30 day readmissions.

Atlantic Quality Innovation Network

Two-Pronged Approach to Management of Anticoagulation in the Peri-Procedural Period: Operationalization of a Mobile/Web-Based Application for Clinical Decision Support in Hospital/​Ambulatory Surgery Settings and Optimization of Patient Education using Health Information Technology

Assist physician offices, pharmacies, hospitals, nursing homes and county health departments to modify and standardize prescribing practices for managing anticoagulants during the peri-procedural period to reduce anticoagulant ADEs in all patients in Orange, Putnam and Dutchess counties of New York.

Expected outcome: Decrease in the number of surgical and invasive procedure cancellations and resultant facility costs due to anticoagulant-related issues in inpatient and ambulatory care settings, decrease in incidence of thrombotic and bleeding events per 1,000 anticoagulated peri-procedural Medicare FFS beneficiaries.

atom Alliance

Addressing Acute Pain Management in Sickle Cell Disease Patients

Working with emergency departments, pilot a web-based sickle cell disease registry and utilize a learning and action network model to share clinical and non-clinical educational elements designed to improve the SCD patient experience and resulting outcomes in Memphis, TN.

Expected outcome: Identification and improvement of acute symptoms for SCD patient treatment, reduced emergency department utilization and reduced admissions, and increased SCD clinical referrals/​visits.

Great Plains Quality Innovation Network

Pain Management and Appropriate Utilization of Opioids

Utilizing the Stanford Chronic Pain Self-Management Program, engage primary care providers and patients in addressing both acute and chronic pain management and appropriate utilization of opioids in four communities across Kansas.

Expected outcome: Reduction in the use of opioids from multiple providers in persons without cancer; relative improvement rate in pain management in short stay and long stay nursing home residents, reduction in provider level opioid prescribing rates, reduction in state wide opioid prescribing rates.

New England Quality Innovation Network

Post-Acute Care Coordination

Implement a systematic discharge process for nursing home residents that results in enhanced care management, safe transitions from one care setting to another, improved health outcomes and reductions in harms in Massachusetts.

Expected outcome: Reduction in 30-day readmissions among Medicare beneficiaries discharged from participating facilities.

Health Insight

Catalyzing Complex Systems Change by Optimizing Patient Flow utilizing the ECHO Model

Demonstrate the effectiveness of the Extension for Community Healthcare Outcomes (ECHO) model to improve patient flow in 50 rural primary care offices across New Mexico, Nevada, Utah and Oregon. Primary interventions include adapting design features and protocols to physician practice redesign.

Expected outcome: Better quality of care, responsible spending, improved patient and provider satisfaction, and increased ability of practices to manage population health.

Health Services Advisory Group

Accelerating Treatment for Better Acute Ischemic Stroke Outcomes

Using a collaborative model engage hospitals, emergency medical service providers and local emergency medical agencies in Contra Costa County California to implement the Stanford Clinical Excellence Research Center ischemic stroke bundle to achieve improved ischemic stroke care.

Expected outcome: Reduction in mortality due to stroke, improvement in symptom to needle time, symptom to endovascular treatment time, door to needle time, door to endovascular treatment time, reduction in stroke in hospital mortality, reduction in stroke readmission in 30 days and increased discharge to home.

Mountain Pacific Quality Health Foundation

Improving Care Transitions in Rural Communities Utilizing the ECHO Model

Improve care transitions for vulnerable populations (e.g., beneficiaries with multiple chronic conditions, behavioral health issues, and dual eligible) across all settings among rural providers in Montana and Wyoming.

Expected outcome: Reductions in admissions, readmissions, increase in community tenure, decrease in total institutional days, reduction in unnecessary emergency department use, and provider satisfaction with participation in ECHO.

Qualis Health

Addressing Social Determinants of Health in Care Transitions: An Integrated Approach to Improve Health Outcomes

Improve the quality, safety, and reliability of the care transition process in Washington and Idaho hospitals by focusing on hospital discharge risk assessment that includes social determinants impacting the beneficiarys transition. Integrating local social service providers into medical providers’ discharge planning and coordination processes, and identification of high utilization areas to help identify community gaps and high priority medical/​social service coordination opportunities.

Expected outcomes: Reduction in hospital admissions, 30-day readmissions, and ER rates for Medicare dual-eligible claims, increase in social determinant screening rates.

Quality Insights Quality Innovation Network

Increasing Annual Wellness Visit Utilization for Medicare Beneficiaries

Increase annual wellness visits among Medicare beneficiaries residing in Delaware, Louisiana, New Jersey, Pennsylvania and West Virginia through education, technical assistance and primary care toolkits.

Expected outcome: Develop pre/post-test design to examine intervention effectiveness on annual well visit utilization by state and provider.

TMF Quality Innovation Network

Capitalizing on Chronic Care Management Services

Develop and implement a chronic care management (CCM) learning and action network for 100 primary care practices that are using certified electronic health records throughout Arkansas, Missouri, Oklahoma and Texas to integrate chronic care management practices in physician work flow.

Expected outcome: Increase the rate of implementation of CCM by recruited providers, increase CCM claims per beneficiary, reduce hospital admission and readmission rates, examine the unadjusted cost of inpatient and outpatient care for eligible beneficiaries and those who do not get the CCM benefit.