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From Adversary to Partner: Have Quality Improvement Organizations Made the Transition?


  • Elizabeth H. Bradley,

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    • Address correspondence to Elizabeth H. Bradley, Ph.D., Associate Professor, Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06520-8034. Melissa D. A. Carlson. M.P.H., Ph.D. Candidate, is with the Department of Epidemiology and Public Health, Yale School of Medicine, New Haven. William T. Gallo, Ph.D., Associate Research Scientist, is with the Department of Epidemiology and Public Health, Yale University School of Medicine Program on Aging, New Haven. Jeanne Scinto, Ph.D., M.P.H., Director of Quality Improvement, Saint Raphael Health Care System, New Haven. Miriam K. Campbell, Ph.D., M.P.H., Epidemiologist, is with the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Division of Quality Improvement, Boston. Harlan M. Krumholz, M.D., Professor, is with the Department of Internal Medicine, Yale University School of Medicine, New Haven.

  • Melissa D. A. Carlson,

  • William T. Gallo,

  • Jeanne Scinto,

  • Miriam K. Campbell,

  • Harlan M. Krumholz


Objective. To describe the perceived impact of the Centers for Medicare and Medicaid Services Quality Improvement Organizations (QIOs) on quality of care for patients hospitalized with acute myocardial infarction, in the context of new efforts to work more collaboratively with hospitals in the pursuit of quality improvement.

Data Source. Primary data collected from a national random sample of 105 hospital quality management directors interviewed between January and July 2002.

Study Design. We interviewed quality management directors concerning their interactions with the QIO interventions, the helpfulness of QIO interventions and the degree to which they helped or hindered their hospital quality efforts, and their recommendations for improving QIO effectiveness.

Principle Findings. More than 90% of hospitals reported that their QIO had initiated specific interventions, the most common being the provision of educational materials, benchmark data, and hospital performance data. Many respondents (60%) rated most QIO interventions as helpful or very helpful, although only one-quarter of respondents believed quality of care would have been worse without the QIO interventions. To increase QIO efficacy, respondents recommended that QIOs appeal more directly to senior administration, target physicians (not just hospital employees), and enhance the perceived validity and timeliness of data used in quality indicators.

Conclusions. Our study demonstrates that the QIOs have overcome, to some degree, the previously adversarial and punitive roles of Peer Review Organizations with hospitals. The generally positive view among most hospital quality improvement directors concerning the QIO interventions suggests that QIOs are potentially poised to take a leading role in promoting quality of care. However, the full potential of QIOs will likely not be realized until QIOs are able to engender greater engagement from senior hospital administration and physicians.