2014-2019 QIO Quality Report Card

Between 2014 to 2019, Qsource coordinated a regional effort as Medicare’s Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Alabama, Indiana, Kentucky, Mississippi and Tennessee.

During this time, Qsource was successful in performing meaningful and impactful work in patient and family engagement, medication safety, care coordination, diabetes self-management and nursing home care. The following is a snapshot of our work and the results. If you would like more information on how Qsource can help your organization, please contact us.

Antibiotic Stewardship

Antibiotic stewardship helps facilities monitor, reduce and prevent misuse of antibiotics through a multidisciplinary team and strategic approach.

Rates of antibiotic prescribing in the Qsource region are higher than the national average. This is due to disproportionate numbers of health disparities among the Medicare population and in an increase in antibiotic-resistant bacterial infections.

Qsource provides outreach, education and technical assistance to implement the CDC’s Core Elements of antibiotic stewardship in outpatient settings.

Our team is working to establish and implement antimicrobial stewardship program activities that are effective, sustainable, and can be tailored to the clinical needs of outpatient settings.

Our team formed a multidisciplinary advisory team with thought leaders who understand the fundamental principles of antimicrobial stewardship and the unique aspects of stewardship implementation in the outpatient setting. The advisory group yields insights into geographic variations in antibiotic use in outpatient settings, communities and regions.

596
outpatient settings working to combat antibiotic resistant bacteria

100%
of outpatient settings have implemented all 4 of the CDC’s Core Elements and/or Quality Improvement activities

Behavioral Health

For primary care providers working with our Behavioral Health team, improvement started with a screening overview report that outlined the amount of payment they could receive if they include alcohol and depression screenings as part of their patient visit routine. Our team also discovered that one of the most common barriers to performing a screening was the fear of broaching an uncomfortable subject.

With the assistance of Cherokee Health Systems in Knoxville, Tenn., we developed educational resources and tools focusing on Motivational Interviewing (MI). MI is designed to prompt patients to make decisions based on their willingness to change behavior. Clinicians are guided by communication techniques, delivered in a positive and supportive manner, to help encourage patients to make the changes necessary to improve their health.

8,300
primary care clinicians representing

1,055
practice sites implemented a screening process

131,500
people with Medicare were screened for depression

36,300
people with Medicare were screened for alcohol misuse

Cardiac Health

Of the 456 counties that Qsource serves, 269 (or 59 percent) have the highest rates of cardiac-related deaths in the U.S. among people 65 and older. This is a result of our communities having some of the highest rates of diabetes, stroke, cardiovascular disease and obesity in the country.

To reduce the number of cardiac-related deaths in our communities, our team worked with doctors, nurses, Home Health agencies, and other healthcare providers to spread evidence-based practices that promote the use of the Cardiac ABCS – Aspirin, Blood pressure control, Cholesterol management, and Smoking cessation.

We specifically helped physicians, home health providers and other healthcare providers implement protocols for measuring and controlling blood pressure and providing smoking cessation counseling to their patients who smoke. We also directly educated people with Medicare in our communities through events at senior centers, libraries, Kiwanis Clubs, Elks Clubs, faith communities, health fairs and other venues.

237
practices implemented blood pressure protocols

1,236
healthcare providers worked with us to improve cardiac health

10,300
people with Medicare received smoking cessation counseling

34,000
people with Medicare had their blood pressure controlled

158
educational events hosted for people with Medicare

Care Coordination

One in five Americans aged 65 and older is readmitted to the hospital within 30 days of discharge, but most readmissions are preventable.

Qsource increased collaboration among healthcare providers in specific areas, improving their knowledge base, teamwork and the care delivered. Many of our tools were designed to enhance a patient’s understanding of their condition(s) and the need to stay healthy.

We engaged state hospital associations in a highly collaborative way to enhance our efforts and help our team build relationships with post-acute facilities, physician practices and outpatient centers. Involving all representatives of the care continuum was critical.

By decreasing hospital admissions and readmissions, more people with Medicare stayed at home where they wanted to be.

36
care coordination communities engaged

2,251,846
people with Medicare potentially impacted

1,135,999
people with Medicare in rural areas potentially impacted

892
healthcare providers recruited

3,600
hospital readmissions avoided

$46 million
in readmissions costs avoided

22,000
hospital admissions avoided

$236 million
in hospital admission costs avoided

120
community leaders engaged in a learning network

“Qsource helped us strategize the most efficient ways to get the medical organizations to convene and work together as a coalition.”— Thomas Preston, Assistant Director Southeast Tennessee Area Agency on Aging and Disability (SETAAAD)

Diabetes Care

Nearly one-third of adults 65 years and older in the United States have diabetes. It is a leading cause of heart disease and stroke and the most common cause of blindness, kidney failure and amputations in adults. Ethnic and racial minorities have a higher prevalence of diabetes than Caucasians. Qsource aimed to change that, so we taught diabetes self-management education (DSME) classes to adults in our communities, with a focus on underserved populations and promoting population health.

DSME gives people with diabetes the knowledge and skills they need to improve their quality of life and helps prevent or lessen the severity of complications that may result from diabetes. Qsource offered DSME classes in medically underserved and rural communities. To recruit DSME students and identify convenient class locations, we collaborated with senior housing management agencies, faith-based organizations, senior centers, community centers, hospitals, physician groups and government agencies.

We also helped physician practices that were interested in developing their own DSME programs train their own DSME trainers and understand the requirements for becoming a certified diabetes center. To sustain our efforts, we trained and built a network of educators who will continue to provide DSME education to people with diabetes and their caregivers throughout our communities.

347
practices increased their adherence to clinical guidelines for appropriate utilization for HbA1c, lipids and eye exams

4,854
people completed a DSME program

193
diabetes educators were trained to conduct DSME workshops

“I don’t think there was anyone not touched by the testimonials shared in class yesterday. Tears were shed. I think we can all get caught up in the data and the numbers sometimes. But this education curriculum is so vital to strong support systems and the encouragement to people who need this.” – Peer Educator

“I learned that diabetes can be controlled. It’s not a death sentence, but you have to work at it. It’s a lifestyle change.” – Graduate

Immunizations

Historically, immunization rates among older adults have been low. Qsource showed providers how to maximize immunizations by teaching their Medicare patients important information about staying healthy, overall wellness and managing chronic conditions such as diabetes and cardiovascular disease.

Our team recruited host sites to hold shot clinics – often coordinating with pharmacies to make the clinics a success. We conducted in-service training to create a pro-vaccination culture in healthcare practices and identified points in the clinical workflow where vaccinations could be discussed with patients.

465
providers improved their vaccination rates

111
home health agencies improved their vaccination rates

159
vaccination clinics and community outreach events held

950
vaccinations administered

Medication Safety

Adverse drug events (ADEs) are a leading cause of preventable patient harm, disproportionally affecting people with Medicare over the age of 65. With an increasing number of the Medicare patients taking prescription medications and seeing multiple providers, medication safety in all healthcare settings is essential to care coordination and improving patient health.

Qsource is working with healthcare providers, communities, and patients to improve medication safety and reduce and prevent ADEs by helping to identify barriers to reduction and implementing best practice strategies.

The ADE rate in Qsource states is higher than the national rate at 50 per 1,000 compared to 48 per 1,000. To address the high rate of ADEs in our large rural population, Qsource convened local medication safety workgroups in each state.

276,660
people with Medicare at high risk were screened for ADEs

902
facilities, clinicians and practices worked on improving medication safety

34
medication safety workgroups were established

593
stakeholders participated in a medication safety workgroup

65
interventions were implemented through the medication safety workgroups

9.9%
relative improvement rate for reduction of ADEs

Nursing Home Care

There are 1.5 million Americans living in the nation’s 15,600 nursing homes. We depend on nursing homes to provide reliable, compassionate, high-quality care. Our team worked to instill process improvement practices, eliminate healthcare-associated conditions and improve resident satisfaction in nursing homes.

Qsource experts engaged nursing home providers, people with Medicare, partners, stakeholders and communities in an integrated multi-state learning and action network leveraging breakthrough collaborative methodology. Our team also prepared data feedback reports quarterly with composite score data to guide the nursing home leaders’ performance improvement activities.

1,208
nursing homes joined a collaborative to learn the best practices for preventing harm

622
nursing homes improved their composite score measures to 6.0 or lower

5,751
fewer nursing home residents on unnecessary antipsychotic medications

3,000
fewer nursing home residents had urinary tract infections

1,504
fewer nursing home residents reported moderate to severe pain

1,059
fewer nursing home residents had catheters which reduces the chance for infections

1,041
nursing home residents received a flu shot

“The team from Qsource did a webinar with us to show us our different measures, what they currently were and how we could improve them.” – Becky Lewis, Administrator at Ave Maria Home, Memphis, Tenn.

Pain Management and Opioid Reduction

Through a Special Innovation Project (SIP), awarded from the Centers for Medicare & Medicaid Services (CMS), Qsource is working collaboratively with multiple partners and stakeholders and with area physicians, nurse practitioners and dentists in Clinton County, Indiana to decrease opioid use and prescribing.

We partnered with Healthy Communities of Clinton County and the Indiana University Health Frankfort Hospital to educate prescribing physicians and their patients about opioid misuse and developed a communications campaign to raise awareness for how to safely use, store and dispose of pain medications. The campaign included billboards, social media promotion and an educational website.

723
fewer opioid prescriptions were written

83.2%
reduction in prescribing of opioids in the emergency department

87%
of recruited prescribers have implemented at least one intervention

Quality Payment Program

We are committed to providing technical assistance to support healthcare providers’ quality improvement and reporting efforts, so they can spend more of time on patient care. Our team helps healthcare practices in our five-state region find the free resources and tools to be successful in the Quality Payment Program, and provides technical assistance to inform, implement and measure their practice transformation to patient-focused care.

24,490
clinicians received technical assistance

42,000
providers were impacted through partnerships with stakeholders

168
social media messages viewed

85
hospitals received technical assistance to improve outpatient quality measures

93
hospitals received technical assistance to improve inpatient quality measures

92
ambulatory surgical centers, inpatient psychiatric facilities, and critical access hospitals received technical assistance

“We didn’t even know how the process was going to start with QPP reporting. Qsource not only gave us the beginning steps but an explanation of the reporting as well.” – Provider in Indiana

“They helped me and my provider realized QPP is not a bad thing. It is actually designed to help us in many ways. They have helped me all the way since QPP started and continue to help guide us through this.” – Practice Administrator in Tennessee