QIO Program 2021 Yearly Summary
January 1, 2021 - December 31, 2021
A Message from Leadership
Health systems and patients across the country are now entering a new reality almost 3 years after the start of the pandemic. The COVID-19 pandemic has presented a unique set of challenges to quality and safety in health care institutions across the country, introducing uncertainty and new information much faster than the system could handle and apply. As our collective experience and scientific evidence changed, so did the recommendations and guidelines from regulatory agencies. Interestingly enough, and certainly a validation of the critical role we play, the thing that kept health facilities in a place where they could manage the pandemic bravely and innovatively, was their implementation of the QI process on a daily basis. Their response to the pandemic required a dynamic, rapid cycle, plan-do-study-act approach, thereby leaving them no choice but to implement the principles of QI, whether it was patient triage, use of Personal Protective Equipment, procuring supplies, testing, visitation, managing the workforce or complying with guidance.
In 2021, the COVID-19 pandemic continued to have an enormous impact on the entire health care system. In addition to CMS’ ongoing efforts to increase COVID-19 infection prevention and control, vaccinations and boosters, the Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) and Hospital Quality Improvement Contractors (HQICs) Program partnered with health care providers to strengthen infection control systems, manage and mitigate the spread of COVID-19, reduce opioid misuse and improve patient safety and care coordination. As directed by CMS, our Quality Improvement contractors provided technical assistance and education to 1,961 primarily small, rural, critical access hospitals, 11,179 nursing homes, and 519 community partnerships across the country to implement quality improvement and patient safety initiatives. In 2021, good progress was made in reducing adverse drug events, increasing patient safety and care coordination, improving resident function in nursing homes, and addressing the needs of nursing home residents and staff related to COVID-19 infection prevention and vaccinations. All of this would not have been possible without the integrated and coordinated approach used by CMS, and all of our Quality Improvement Contractors, in engaging with national and local stakeholders, provider associations, patient advocacy groups, health department entities at the state and local levels, and our federal and private sector colleagues. Edwards Deming famously said that "Quality is everyone's responsibility." It took a committed network of dedicated, mission-focused partners to realize good outcomes, and improvements in quality and safety for the people we serve. We are proud of the work completed throughout 2021. Especially important were efforts to reduce harm from COVID-19 through improved infection prevention practices and vaccination. We look forward to continuing this work in 2022 and the years beyond.
Anita Monteiro, RN, MA, MS, MBA
Director, iQuality Improvement and Innovation Group (iQIIG)
Center for Clinical Standards & Quality
How We Help People with Medicare
Led by the Centers for Medicare & Medicaid Services (CMS), the Quality Improvement Organization (QIO) Program works with health care providers and local and tribal communities to improve health care quality, access, value and equity for people with Medicare. This effort is carried out through five initiatives:
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Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) work directly with nursing homes, health care providers and Partnerships for Community Health (formerly community coalitions) serving rural and underserved areas to improve the quality and safety of care for people with Medicare.
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Hospital Quality Improvement Contractors (HQICs) work directly with small, rural, critical access and some urban hospitals to improve health care quality and safety for people with Medicare.
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The American Indian/Alaska Native Healthcare Quality Initiative (AIANHQI) supports 25 small, rural and critical access hospitals and those that partner with tribal communities through the Indian Health Service.
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The Opioid Prescriber Safety and Support (OPSS) initiative that provides national outreach and education to eligible providers to promote safe opioid prescribing practices and spread knowledge of non-opioid pain management therapies.
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Beneficiary & Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) help people with Medicare, their families and caregivers exercise their right to high-quality health care. Learn more about BFCC-QIOs and locate the BFCC-QIO in your area.
Many Quality Programs, Common Goals
The QIO Program's initiatives address health care challenges and reduce disparities to achieve these goals:
By the Numbers
Under the direction of the Centers for Medicare & Medicaid Services (CMS), the QIO Program partnered with health care providers in 2021 to reduce opioid misuse, improve patient safety and care coordination, and increase COVID-19 infection prevention and control, vaccinations and boosters.*
Initiative Highlights
1,961
Enrolled HQIC hospitals
519
Enrolled Partnerships for Community Health (formerly community coalitions)
11,179
Enrolled nursing homes
Outcomes
Behavioral Health and Opioid Utilization and Misuse
The QIO Program helps health care providers implement evidence-based practices for pain management and opioid use to decrease adverse drug events and deaths.
QIN-QIOs and HQICs work nationwide with hospitals, nursing homes and Partnerships for Community Health to decrease opioid adverse drug events (ADEs) among people with Medicare.
10%
Reduction in opioid ADEs among patients treated at enrolled hospitals
24%
Reduction in opioid ADEs among people with Medicare served by enrolled Partnerships for Community Health
15%
Reduction in opioid ADEs among long-stay residents in enrolled nursing homes
QIN-QIOs and HQICs work nationwide with hospitals, nursing homes and Partnerships for Community Health to help prevent hospital-acquired infections like Clostridioides difficile infection (CDI). Enrolled hospitals, nursing homes and Partnerships for Community Health have significantly reduced CDI events since 2018.
Patient Safety
The QIO Program helps health care providers implement evidence-based practices for pain management and opioid use to decrease adverse drug events and deaths.
The QIO Program helps nursing homes and hospitals establish processes and implement evidence-based practices to prevent adverse drug events and reduce readmissions.
14%
Reduction in CDI among patients treated at enrolled hospitals
28%
Reduction in hospital utilization for CDI among people with Medicare served by enrolled Partnerships for Community Health
30%
Reduction in hospital utilization for CDI among long-stay residents in enrolled nursing homes
Care Coordination
QIN-QIOs and HQICs work with hospital leaders, clinical teams and community partners to refine care coordination processes to reduce unplanned hospital admissions.
21%
38%
Reduction in 30-day readmissions (per 1,000 Medicare beneficiaries) served by enrolled Partnerships for Community Health
Reduction of hospital utilization for people with Medicare who have complex health needs (per 1,000 beneficiaries) residing in enrolled Partnerships for Community Health
The QIO Program helps health care providers develop processes to better coordinate care and improve communication with post-acute providers, people with Medicare and their families.
3%
Reduction in the percentage of 30-day readmissions for enrolled hospitals
6%
Decrease in emergency department visits among long-stay residents in enrolled nursing homes
15%
Decrease in hospitalizations among long-stay residents in enrolled nursing homes
Nursing Homes/Long-Term Care
In the nursing home setting, hospitalizations per 1,000 long-stay resident days declined by 20%. Other improvements were made in several patient harm measures.
The QIO Program helps nursing homes improve their overall Five-Star Quality Rating and quality measure ratings on clinical measures for resident care.
Percentage of short-stay residents who made improvements in function increased by
21%
Percentage of long-stay residents who have or had a catheter inserted and left in their bladder decreased by
25%
Percentage of long-stay residents with a urinary tract infection (UTI) decreased by
17%
COVID-19
The QIO Program helps deliver timely information to health care providers about COVID-19 regulations and guidance. The Program also addresses their pressing needs such as overcoming vaccine hesitancy, encouraging vaccine and booster uptake and building resilience.
The COVID-19 pandemic has had an enormous impact on the entire health care system. The effects are especially felt in nursing homes. The medically vulnerable nature of the nursing home population, combined with the inherent risks of congregate living in a health care setting, have required aggressive and detailed efforts to limit COVID-19 exposure. QIN-QIOs have helped nursing homes increase vaccination rates for their residents and staff.
87%
Nursing home residents received a primary series of the COVID-19 vaccine as of January 2, 2022
81%
Nursing home staff received a primary series of the COVID-19 vaccine as of January 2, 2022
Work in Action
Hover over the images below to view snapshots of the QIO Program in action. You will find stories demonstrating how the QIO Program, led by the Centers for Medicare & Medicaid Services (CMS), works directly with providers and communities, tools that help providers establish processes that improve care and educational resources for providers and people with Medicare.
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COVID-19: The QIO Program helps deliver timely information to health care providers about COVID-19 regulations and guidance. The Program also addresses providers' pressing needs such as overcoming vaccine hesitancy, encouraging vaccine and booster uptake and building resilience.
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Health Equity and Reducing Disparities: The QIO Program works to identify, address, track and reduce health care disparities among people with Medicare.
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Patient and Family Engagement: The QIO Program seeks out the values and preferences of people with Medicare, their families, their caregivers and their advocates and integrates these perspectives into quality improvement activities.
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Behavioral Health and Opioid Utilization and Misuse: The QIO Program helps health care providers implement evidence-based practices for pain management and opioid use to decrease adverse drug events and deaths.
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Patient Safety: The QIO Program helps nursing homes and hospitals establish processes and implement evidence-based practices to prevent adverse drug events and infections and reduce readmissions.
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Chronic Disease Self-Management: The QIO Program provides evidence-based treatment recommendations for cardiac and vascular health, diabetes and End Stage Renal Disease and connections to local resources for people with Medicare like disease self-management and lifestyle change programs.
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Care Coordination and Reducing Readmissions: The QIO Program helps health care providers develop processes to better coordinate care and improve communication with post-acute providers, people with Medicare and their families.
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Nursing Home Quality: The QIO Program helps nursing homes improve their overall Five-Star Quality Rating and quality measure ratings on clinical measures for resident care.
This material was prepared by The Bizzell Group (Bizzell), the Data Validation and Administrative (DVA) contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Views expressed in this document do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. 12SOW/Bizzell/DVA-0800-12/31/2021.