Sponsor

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS)

Description

Under the direction of CMS, the QIO program consists of a national network of fifty-three 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. The program also safeguards the integrity of the Medicare trust fund by ensuring payment is made only for medically necessary services, and investigates beneficiary complaints about quality of care.

For the QIOs' current (2002-2005) contract cycle, CMS has expanded performance expectations to encompass two additional health care settings, - nursing homes and home health agencies.

Data collection

Data are collected by the national network of fifty-three QIOs responsible for each U.S. State, territory, and the District of Columbia according to data collection tools developed by QIOs or related organizations. Data for the AMI and pneumonia measures are a systematic random sample of up to 750 inpatient records per State. Data for the heart failure measure are from a systematic random sample of up to 800 inpatient records per State.

Primary Content

Current national priorities includes in four health care settings: nursing home, home health agencies, hospitals and physician offices. QIOs' measures included in the NHQR are hospital settings, including those related to: acute myocardial infarction; heart failure; and pneumonia.

Population Targeted

Medicare beneficiaries as required for the relevant measure.

Demographic Data

Age, race, gender.

Contact Information

Agency homepage: http://www.cms.hhs.gov

Data system homepage: http://www.cms.hhs.gov/QualityImprovementOrgs/

References

QIO Statement of Work at http://www.cms.hhs.gov/QualityImprovementOrgs/

CMS and QIOs' public Web site at http://www.medqic.org/