Successful Pilot Projects Spur National Effort to Improve Care for Older Americans

JAMA Study Releases First National Snapshot of Quality Of Care for Medicare Beneficiaries

WASHINGTON, Oct. 2  -- Physicians, hospitals and quality experts working together can measurably improve care for older Americans, according to a report issued today by the American Health Quality Association (AHQA), a national, non-partisan, not-for-profit group dedicated to health care quality improvement.

The report, A Measure of Quality: Improving Performance in American Health Care, documents the results of more than 300 community-based projects conducted in 1996-99 by Medicare's private quality experts, known as peer review organizations (PROs). The pilot projects involved almost 10,000 hospitals and caregivers and fostered improved care for an estimated 16 million Medicare beneficiaries. The projects were the model for Medicare's new coordinated national campaign to improve care for beneficiaries in six critical disease areas -- heart attack, breast cancer, diabetes, heart failure, pneumonia and stroke.

``The success in improving care for older Americans is a direct result of the cooperation and commitment of physicians, hospitals and other caregivers,'' said David Thomas, M.D., an Iowa family physician and president of the American Health Quality Association. ``Medicare peer review organizations work with physicians and hospitals to identify and fix systemic problems that prevent Medicare beneficiaries from getting the right care at the right time.''

The main goal of PROs is to move the findings of science and evidence from the bookshelf to the bedside. Medical professionals are bombarded every day with new information, making it difficult for them to stay on top of which new procedures and treatments are saving lives. Today's complex health care system requires physicians, pharmacists, nurses and aides to interact effectively to provide care for each patient. PROs work with physicians, hospitals and other caregivers to examine and organize care delivery systems to help make sure patients get the right care at the right time.

PROs don't use a regulatory or enforcement approach. The report shows how they have succeeded with a voluntary, collaborative, non-punitive educational model to encourage health care providers to identify opportunities to improve the way care is delivered.

``Casting blame and pointing fingers won't spur better performance in health care,'' AHQA Executive Vice President David Schulke said. ``We have to be able to get beyond that kind of thinking and acknowledge that there is always room for improvement. Then we have to work together to improve the quality of care in a systematic and measurable way for all Americans.''

Based on the promising early results of the local pilot projects, the Health Care Financing Administration (HCFA), which runs Medicare, decided about a year ago to focus the collective power of the PROs and the nation's hospitals and physicians on a national campaign to improve care for beneficiaries in six critical disease areas -- heart attack, breast cancer, diabetes, heart failure, pneumonia and stroke. Taken together, these diseases pose the greatest risk to seniors' lives and health. Yet, there are many treatments and preventive steps -- like quickly getting aspirin after a heart attack or an annual flu shot -- that can manage these diseases and help seniors live longer, happier and more productive lives.

To guide national quality improvement efforts, HCFA collected information about the care Medicare beneficiaries received in 1997-99 based on 24 clinical indicators in the six targeted disease areas.The results of this first-ever national snapshot of the quality of care in fee-for-service Medicare are scheduled for publication in the Oct. 4 Journal of the American Medical Association and clearly show that tremendous opportunities remain to improve care for older Americans.

``Gathering information about beneficiaries' quality of care is an important milestone for Medicare and provides a roadmap that is essential to improving performance,'' Thomas said. ``Once we have the information needed to target quality improvement activities, we can improve care and measure our progress.''

Local PROs have the solid relationships with physicians, hospitals and other caregivers needed to make meaningful changes in how care is delivered. This approach works. For example, according to Medicare, PRO projects:

    * To improve care for heart attack patients save an estimated 3,000 lives
      a year.
    * To increase the rapid first administration of antibiotics help prevent
      an estimated 700 deaths annually of Medicare beneficiaries with
      pneumonia.
    * To increase the appropriate use of blood thinners for people at risk of
      having a stroke prevent an estimated 1,285 strokes annually.

Typically, PROs identify clinical indicators -- like the number of minutes it takes to administer certain drugs to heart attack patients or the percentage of people with diabetes who get regular eye exams -- that reflect the quality of health care services. PROs measure how often care is delivered in accordance with the quality indicators. When there is a gap between the accepted standard of care and the actual care provided, PROs work with physicians and other caregivers to examine their practices and change how they provide care. PROs provide suggestions based on successful improvement projects in other hospitals and clinics consistent with the medical literature. They then remeasure the indicators to find out if the quality improvement intervention succeeded.

The HCFA data show that there are gaps in care for older Americans. For example, medical experts agree that many patients whose hearts beat irregularly due to a condition called atrial fibrillation, and who are, therefore, at risk of having a stroke could benefit from a blood-thinning medication called warfarin. According to the HCFA data, however, almost half of all Medicare beneficiaries who should receive warfarin (Coumadin) don't get this medication. The AHQA report, A Measure of Quality: Improving Performance in American Health Care, shows that 26 local quality improvement projects conducted in 1996-99 involving more than 160,000 Medicare beneficiaries increased the number of clinically appropriate patients receiving warfarin by 23 percent.

Likewise, studies have shown that screening mammograms can prevent roughly one in four breast cancer deaths. But the HCFA data show that almost half of all women Medicare beneficiaries between the age of 52 and 69 don't get a mammogram at least every two years. According to the AHQA report, 11 projects in 1996-99 involving almost 675,000 beneficiaries increased the number of beneficiaries receiving screening mammograms by 25 percent.

The full AHQA report and other information about the nation's national network of peer review organizations are available on the Web at www.ahqa.org.

The American Health Quality Association is the national, not-for-profit membership association of independent, community-based Quality Improvement Organizations (QIOs), better known as Peer Review Organizations (PROs) for their Medicare work. The QIOs/PROs represent the 50 states, the District of Columbia and the U.S. territories in working collaboratively with health care practitioners, health plans and hospitals to analyze health care patterns, to identify opportunities for improvement, and to interpret and share information about current science and best practices with physicians, hospitals and other caregivers.