JAMA Study Shows Improved Hospital Admission and Readmission Rates Associated with Qualis Health-Initiated Project in Washington State

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Efforts to improve care transitions for patients and families drive results in Whatcom County.

Thanks to QIOs, these communities created networks of clinicians, facilities, families, social services agencies, and others that share a common language in coordinating care for patients—the community’s sickest and most vulnerable people.

Researchers in the January 23rd issue of the Journal of the American Medical Association (JAMA) report that an effort initiated by Qualis Health in Whatcom County, Washington, reduced hospitalization rates by nearly 6% and readmission rates by nearly 7%. The authors assess efforts conducted by Quality Improvement Organizations (QIOs) including Qualis Health in 14 select communities nationwide, and show that interventions aimed at improving care transitions—when patients move from one care setting to another, such as from a hospital to their home—yielded significant results.

The study shows that hospitalizations and rehospitalizations among Medicare patients declined nearly twice as much in communities where QIOs coordinated interventions that engaged whole communities to improve care than in comparison communities. Qualis Health is one of the 14 state-based QIOs that received funding from the Centers for Medicare & Medicaid Services (CMS) to participate in the project.

Despite initial hospitalization and rehospitalization rates that were the lowest among the 14 communities nationwide, the Washington State project showed that reductions are achievable even in a high-performing community like Whatcom County. And the results in Whatcom County are significantly better than three Northwest comparison communities that were not working with Qualis Health.

“Improving hospital admission and readmission rates isn’t only a hospital issue,” says Jonathan Sugarman, MD, MPH, Qualis Health President and CEO, “it requires coordination across the entire community to provide the right care for patients and families. We want to acknowledge the efforts of this project’s participants and leaders across Whatcom County, including PeaceHealth St. Joseph Medical Center, and congratulate them on this accomplishment.”

Readmitting Medicare patients to the hospital within a month of discharge is a frequent—and costly—occurrence. Almost 25% of heart failure patients on Medicare, for example, are readmitted to the hospital within 30 days of discharge. The federal government says avoidable hospital readmissions cost the Medicare program billions of dollars a year. “The QIOs’ work in this project shows a reduction in hospitalization and rehospitalization rates, which are vitally important for keeping Medicare beneficiaries as healthy as possible for as long as possible,” said Patrick Conway, MD, MSc, CMS Chief Medical Officer and Director of the agency’s Center for Clinical Standards & Quality. “Thanks to QIOs, these communities created networks of clinicians, facilities, families, social services agencies, and others that share a common language in coordinating care for patients—the community’s sickest and most vulnerable people. These communities effectively prevented hospitalizations, resulting in people being more likely to stay home and healthy.”

In 2008, CMS selected Qualis Health and 13 additional QIOs to participate in a three-year project to use quality improvement strategies to improve care transitions for an entire community in their state. In the state of Washington, Qualis Health successfully engaged providers, patients and community partners across Whatcom County to reduce unnecessary rehospitalizations through “Stepping Stones: Bridging Healthcare Gaps,” the Care Transitions Project of Whatcom County. Working together, Qualis Health and the community met the project’s goals, and the effort helped Whatcom County organizations successfully qualify in 2012 for federal Community-Based Care Transitions Program funding to continue the effort on behalf of their Medicare population.

As the QIO for Idaho and Washington, Qualis Health now provides resources and support for healthcare providers and community partners across the entire region, spreading the success of what worked in Whatcom County. In addition, Qualis Health is providing direct assistance to targeted communities that represent 57% and 85% of the Medicare population in Idaho and Washington, respectively, and 56% and 86% of each state’s Medicare hospital admissions.

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About Qualis Health and the Medicare QIO Program
Qualis Health is a national leader in improving care delivery and patient outcomes, working with clients throughout the public and private sectors to advance the quality, efficiency and value of healthcare for millions of Americans every day. Visit Qualis Health on the web at http://www.qualishealth.org.

Qualis Health serves as Medicare’s Quality Improvement Organization (QIO) for Idaho and Washington. The QIO Program is an integral part of the U.S. Department of Health and Human Services’ National Quality Strategy to transform America’s healthcare system. Under contract with CMS, the QIOs serve as the largest federal program dedicated specifically to improving healthcare quality at the community level. For more information, see http://www.qualishealthmedicare.org.

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This material was prepared by Qualis Health, the Medicare Quality Improvement Organization for Idaho and Washington, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. WA-C10-QH-1016-01-13

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Evan Stults
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