Making Significant Improvements through Minnesota's Medicare QIO Projects

Advancing patient safety and quality improvement for Medicare consumers

By participating in Medicare Quality Improvement Organization (QIO) projects over the past three years, health care providers and organizations in Minnesota made significant improvements in health care processes and patient care, as assessed by more than 40 measures. As Minnesota's Medicare QIO, Stratis Health developed and led evidence-based clinical initiatives and provided objective expertise to meet national health care priorities, which focused on the greatest needs and opportunities for improvement identified by the Centers for Medicare & Medicaid Services (CMS).

Adult primary care clinics

Stratis Health is working with 10 clinics to leverage electronic health record (EHR) systems to support evidence-based practice that will improve preventive health care for Medicare consumers. The clinics modify clinical workflows to achieve greater efficiency with EHRs, fully utilize EHRs to coordinate patient care, and extract and report data from their EHR system to support quality improvement. The clinics achieved two-year target goals within the first year of the project. Rates improved dramatically for the four preventive screening measures:

• Influenza immunization—from 44.24% to 47.29%
• Pneumoccocal immunization—from 25.33% to 49.95%
• Colorectal cancer screening—from 28.30% to 38.96%
• Mammography—from 35.79% to 45.36%

Hospitals

Stratis Health has been providing tailored technical assistance for patient safety to hospitals on clinical quality, teamwork, organizational culture, and leadership. Nine Minnesota hospitals are participating in a project to improve surgical care by reducing surgical complications and improving heart failure treatment. The project focuses on preventing complications in four areas that comprise 40 percent of the most common complications after major inpatient surgery: infection, blood clots, and adverse cardiac and respiratory events.

• Collectively,

the hospitals are improving on 7 of 8 measures, exceeding 5 benchmarks

We are working with two Minnesota hospitals to maintain low methicillin-resistant Staphylococcus aureus (MRSA) infection rates. Only one hospital-acquired MRSA infection has occurred during the project.
Stratis Health supported transparency in health care quality and patient safety by working with all Minnesota hospitals to collect and submit quality data to Hospital Compare, and by offering educational and technical assistance on the use of CMS reporting specifications, systems, and tools.

• 100% reporting by critical access and prospective payment system hospitals
  

We collaborate with the Minnesota Hospital Association to calculate and publish measures of Minnesota hospital performance, including clinical quality and patient experiences of care, on Minnesota Hospital Quality Reports.

Nursing homes

Working with 43 nursing homes to reduce the incidence of pressure ulcers and the use of physical restraints, Stratis Health provided assistance with implementing evidence-based practices, organizational leadership assessment, and support for culture change toward person-centered care. tools.

• Pressure ulcers rates decreased from 11.27% to 9.08%
• Use of physical restraints decreased from 4.65% to 1.69%
  

Stratis Health provided quality improvement technical assistance to three nursing homes identified by CMS as having a history of serious quality issues. All of the homes have taken steps to improve and have successfully graduated from the CMS special focus facility list.

Health plans

Stratis Health worked with one Minnesota health plan to improve drug safety by identifying top medications associated with drug-drug interactions (DDIs) and potentially inappropriate medications (PIMs) in the elderly, then developing educational and system strategies with providers, pharmacies, and care coordinators to address these medications. The health plan far exceeded improvement goals. Its DDI and PIM rates improved faster than the rates of other Minnesota health plans.

Medicare beneficiaries

In addition to our assistance to health care organizations, Stratis Health works in protecting beneficiaries and promoting health care value by addressing quality of care complaints and reviewing discharge appeals. In our 2008-2011 QIO work to date, we responded to nearly 3,500 Medicare medical record review cases and fielded 4,450 help-line calls.

Stratis Health QIO results fact sheet