QIOs in Action: Focusing on Populations with the Greatest Need

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Health care quality improvement is not just about improving health; it is about improving health in a way that fosters equitable opportunities for and access to care for all members of the population regardless of geography, race, ethnicity, income or other socioeconomic differences. Aggregated health indicator data often masks health disparities impacting particular communities. These failures to identify health gaps can lead to significant and avoidable differences in quality of life and life expectancy, according to health care experts.

Lake Superior Quality Innovation Network (QIN) — the QIN-Quality Improvement Organization (QIO) serving Michigan, Minnesota and Wisconsin — targeted disparities interventions in high-risk geographic areas determined by disease prevalence and utilization trends, such as high rates of diabetes or low immunization rates.

By working with community-based organizations and community members,the QIN-QIO focused on better understanding social and environmentaleffects on health and access to care, developing strategies for assistance and engagement in underserved populations.

Efforts to reduce health disparities were enhanced by collaboration with partners like state Medicare Rural Hospital Flexibility (Flex) programs for quality improvement capacity and performance in critical access hospitals; state health departments to reduce disparities in cardiac health and diabetes management; Hospital Improvement Innovation Networks to improve care transitions and reduce readmissions; and tribal communities to initiate antibiotic stewardship programs. 

Addressing Disparities in Diabetes

Lake Superior QIN’s diabetes-fighting initiative focused on individuals with a diagnosis of diabetes or prediabetes who were in at least one of these underserved populations: racial minority, rural geographic location or lower socioeconomic status. Diabetes Self-Management Education (DSME) is a critical element of care for people with diabetes or at risk for developing the disease. 

To reach underserved populations, Lake Superior QIN provided diabetes education to individuals in Michigan homeless shelter day centers and developed agreements with public housing authorities in Minneapolis and St. Paul, Minn., to offer DSME workshops onsite to low-income residents. 

Given that some of the largest disparities in care among Medicare beneficiaries are in rural, underserved areas, the QIN-QIO hosted 390 DSME workshops, each consisting of six classes, in rural areas. Nearly half of beneficiaries who completed the DSME classes in Michigan, Minnesota and Wisconsin (1,562 people total) were from rural areas. 

DSME programs are estimated to help prevent or delay the complications of diabetes and reduce health care costs by as much as $900 per person annually, according to one study, and potentially saves Medicare $1.4 million annually. 

Rural DSME workshop participants demonstrably improved their understanding of diabetes self-management, comparing pre- and post-survey responses. As the numbers below illustrate, this work shows that initiatives focused on underserved populations can drive impactful change. 

Rural 
Non-rural 
Non-white 
Increase in beneficiaries reporting they knew healthy ways to handle the stress of diabetes
145%
118%
111%
112%
Increase in number of graduates reporting they eat at least five fruits or vegetables per day
29%
27%
18%
12%
Decrease in number of beneficiaries reporting they checked their blood sugar zero days per week
54%
42%
43%
39%
Increase in number of beneficiaries reporting they checked their feet at least five times per week
26%
24%
21%
25%