Frequently Asked Questions
Do you have a question that hasn't been addressed? Contact us at QIO-Info@ipro.org

Working with Us

Community of Care Coalitions

Nursing Home Quality Care Collaborative (NHQCC)

More Information about Specific Activities

About Our Contract with the Centers for Medicare & Medicaid Services (CMS)


Working with Us
Who is the IPRO QIN-QIO?

The IPRO Quality Innovation Network-Quality Improvement Organization (QIN-QIO) is a collaboration of three established quality improvement organizations-IPRO, Healthcentric Advisors, and Qlarant-working together to lead quality improvement initiatives in 11 states (NY, NJ, OH, NH, VT, ME, MA, CT, RI, MD, and DE) and the District of Columbia.

We are seasoned and skilled clinicians, administrators, subject matter experts, and change agents who have vast and varied experience in the health care industry. We offer practical solutions to your most challenging issues.

What are CMS' goals for this work?

QIN-QIOs are charged with providing targeted assistance to nursing homes and communities in rural areas, those serving the most vulnerable populations and those in need of customized quality improvement assistance. Through this body of work, CMS and the QIN-QIOs are focusing on results, protecting taxpayer dollars, and most importantly, ensuring the safety and quality of care delivered to every beneficiary.

Who should collaborate with the IPRO QIN-QIO?

The IPRO QIN-QIO collaborates with health care providers across the care continuum, including:

  • Hospitals and health systems
  • Nursing centers, including long-term and short-stay facilities
  • Home health care agencies
  • Community pharmacies
  • Urgent care facilities
  • Ambulatory care providers and clinicians
  • Community-based organizations

What are the benefits of partnering with the IPRO QIN-QIO?

Nursing centers participating in the Nursing Home Quality Care Collaborative (NHQCC) will receive technical support and assistance, at no cost, to help you transform the quality of care provided by your staff, improve resident outcomes, increase satisfaction scores, and elevate your star rating. Specifically we will support you to

  • Improve quality measures and address problems that negatively impact your Star rating
  • Establish and reinforce a culture of safety to enhance your bottom line
  • Develop strong care teams using principles of Quality Assurance & Performance Improvement (QAPI)
  • Make data-driven decisions to craft solutions customized to your organization
  • Gain ready access to evidence-based tools and resources
  • Create a path to success and sustainability
  • Learn about best practices from peers across the region.

For more information on the benefits participating in the NHQCC, see How will my nursing center benefit from joining the collaborative?

All organizations participating in the Community of Care Coalitions will receive support and resources to improve your processes and build a strong network of providers and community-based organizations that will enhance the health of the community you serve, while achieving your organizational goals. Together, we will focus on improving access to behavioral health services, decreasing opioid misuse, reducing harm from adverse drug events (ADEs) and healthcare acquired infections, supporting prevention and management of chronic disease and improving care transitions to reduce unnecessary hospital utilization. We'll explore opportunities to enhance patient and family engagement, better leverage health information technology, reduce health inequities, and address social determinants of health.

We will work with you to implement evidence-based interventions and best practices that target your specific needs and identify measurement strategies that are feasible and allow you to track improvement in your organization and community.

In addition, as a member our Community of Care Coalition, your team will have access to all of our network resources, including education from recognized experts, access to our extensive resource library which includes the latest evidence-based tools, and the ability to participate in smaller peer-sharing and affinity-based learning groups via our Extension for Community Healthcare Outcomes (ECHO) platform.

For more information about the benefits of participating in Community of Care Coalitions, see How will the IPRO QIN-QIO support Community of Care Coalitions?

What is the Extension for Community Healthcare Outcomes (ECHO)?

Project ECHO® is a lifelong learning and guided practice model that revolutionizes medical education and exponentially increases workforce capacity to provide best practice specialty care and reduce health disparities through its hub-and-spoke knowledge sharing networks. The IPRO QIN-QIO will also use Project ECHO for shared learning events, connecting healthcare providers from all settings across 11 states and the District of Columbia.

Is there a cost associated with collaborating with the IPRO QIN-QIO?

No. Our services are offered free-of-charge; there is no cost to participate. Working with us gives you access to value- and evidence-based improvement tools, educational opportunities, and technical assistance aligned with your goals of providing your patients and residents the safest and highest quality of care possible.

What can a participating provider expect?

The IPRO QIN-QIO supports participating health care organizations to:

  • Establish an internal team to drive your organization’s quality improvement efforts.
  • Use your data to identify gaps in quality and to guide and monitor improvement strategies
  • Develop, implement, monitor, and evaluate sustainable quality improvement plans that support improvement activities

What topic areas will be the focus of our work?

CMS' new initiatives focus on issues that concern us all. These include

  • Tackling the opioid epidemic,
  • Improving access to behavioral health services
  • Reducing all-cause harm with a focus on adverse drug events and healthcare acquired infections,
  • Advancing nursing home quality,
  • Improving chronic disease prevention and management, and
  • Strengthening transitions of care and reducing hospital readmissions.

How long a commitment do we have to make?

Our team will work with recruited nursing centers, Community of Care Coalitions, and key partners/stakeholders on the focus areas over the next five years.

We are feeling a bit overwhelmed at the moment and don't feel we can make the commitment at this time. Can we decide to participate in these initiatives at a later date?

Unfortunately, this is not possible. The work we have been charged by CMS to undertake requires that we begin working with all participating organizations at the same time. That requirement necessitates that by April 17, 2020, we have firm commitments from all nursing homes interested in participating.

Community of Care Coalitions
What is a Community of Care Coalition?

A Community of Care Coalition is a formal, long-term alliance of organizations, groups, and agencies that come together to work toward a common goal, such as reducing avoidable hospital readmissions.

We invite health care providers, community-based organizations, and key stakeholders to join our coalition in key geographic areas within each of our 11 states and the District of Columbia. In partnership with the IPRO QIN-QIO, these organizations will commit to work collaboratively to enhance the health of the Medicare beneficiaries in the communities they serve.

Can any organization, group, or facility join a Community of Care Coalition?

Community coalitions are limited to specific geographic areas in each of our states. However, our education, tools, and resources are available to everyone. Contact us at QIO-Info@ipro.org  to find out if your organization is located in a designated community coalition region.

What is the guiding principle for the Community of Care Coalitions?

The IPRO QIN-QIO supports coalition members in developing a charter that best meets the needs of the community. This charter outlines the mission, leaders, member organizations, and expectations for participation. Our experience is that updating the charter on an annual basis leads to continuing engagement and drives improvement efforts.

How will the IPRO QIN-QIO support Community of Care Coalitions?

The IPRO QIN-QIO will take a data-driven approach to engage coalition members, support community-based root cause analyses, and identify evidence-based and best practice interventions with meaningful (and feasible) measurement strategies to monitor your progress on the journey to improved care. Our team will also connect members of our extensive network and subject matter experts to share successes, challenges, and mitigation strategies.

Do I need to commit to work on all of the focus areas to participate in a Community of Care Coalition?

Our team will work closely with coalition members to identify efforts that most align with organizational needs while driving improvement for the organization and community at large.

Do all participants need to attend Community of Care Coalition meetings?

All coalition participants are expected to commit to the coalition by addressing at least one of the focus areas. Some providers may find it necessary to enhance internal processes before actively joining the coalition. Our team will work closely with coalition members to understand their unique needs and develop an appropriate improvement plan. In our experience, the most successful coalitions are ones in which the members attend as many meetings as possible. The dialogue among participants is an essential component in driving improvements in the community.

Nursing Home Quality Care Collaborative (NHQCC)
How will my nursing center benefit from joining the collaborative?

Organizations participating in the NHQCC will connect with a team of quality improvement professionals from the IPRO QIN-QIO. With our support, your organization will be able to achieve measurable improvement at the system-level and accelerate resident safety and healthcare quality improvement. The NHQCC provides education, resources, data tracking, tools, and technical support to help ensure successful outcomes.

How will the IPRO QIN-QIO assist nursing centers with improving quality measures and additional clinical elements?

We will work side-by-side with nursing centers to improve your total quality score. We will review your Minimum Data Set MDS coding and specific quality measures. Our technical assistance advisors will assist your staff in connecting the dots between the MDS technical specifications of each quality measure, guidance from the RAI Manual, and, ultimately, the quality measure calculations and postings to Nursing Home Compare.

The IPRO QIN-QIO wants participating organizations to be successful. We will support participating nursing centers in implementing strategies that include

  • Establishing an internal team to share project responsibility for your organization
  • Sharing data to identify opioid safety and high risk medication (HRM) management gaps and utilize these data to support HRM ADE prevention and reduction strategies.
  • Developing and implementing a sustainable quality improvement plan to address opioid safety, HRM ADE prevention/reduction, and C.difficile infection reduction.
  • Collecting and sharing information with the IPRO QIN-QIO related to HRM and antimicrobial prescribing patterns (baseline and post intervention) and C. difficile diagnostic and laboratory processes/data.
  • Participating in meetings and learning sessions
  • Implementing and evaluating the impact of one or more intervention strategies.

What is the expectation for staff resources and time allocation throughout this work?

Staff resources:

 
Nursing centers have complete autonomy in determining the number of people involved. The IPRO QIN-QIO asks that organizations identify a champion and a secondary person to lead these improvement efforts. In most cases, organizations work through their QAPI committees and/or create small sub committees to advance improvement.
 
We recognize that nursing centers have diverse organizational structures and resource allocations. Because of that, the time and resources dedicated to quality improvement activities will be determined by the individual nursing center.

Time allocation:

 
Nursing centers that have participated in the past have indicated that dedicating between three and five hours per month to QIN-QIO activities helped them make improvements. Many report that they have incorporated knowledge gained from participation with the QIN-QIO into their daily workflow best practices with proven successful outcomes.
Are nursing homes required to participate in this work by regulation?

There are no regulations requiring participation in our collaboratives. However, the work with QIN-QIOs has helped nursing centers meet state regulatory requirements and improve scores.

I work at a five-star home. Why should I participate?

The IPRO QIN-QIO welcomes the participation of high-performing nursing homes to provide a forum for shared learning and solving challenging problems. The professionals who work in four and five-star homes can describe to others how they implement purposeful actions that lead to tangible results, share successes and discuss how they design, achieve, and sustain improvements. And, you will have the opportunity to learn about best practices implemented by other nursing centers that might help sustain the improvements you've achieved.

What specific measures will participating nursing centers focus on?

We will work with your center to focus on achieving improvements in measures that include:

  • Reduce opioid prescribing (for prescriptions > 90 morphine milligram equivalents (MME) in long term care facilities
  • Reduce adverse drug events (ADE)
  • Improve your Total Quality Score
  • Reduce hospitalizations for nursing center onset C.difficile.
  • Reduce emergency room visits and readmissions in short stay residents
  • Reduce health care related infections

If I enroll in the Nursing Home Quality Care Collaborative (NHQCC) can I also join a Community of Care Coalition?

Yes. If your organization falls into a coalition area, enrolling in the NHQCC will automatically enroll your organization in the Community of Care Coalition. Our team will work closely with you to determine your needs and identify the best approach to drive improvement in your organization.

More Information about Specific Activities
How will you support my organization's efforts to reduce adverse drug events, reduce C.difficile infections, and decrease opioid misuse?

Adverse drug events (ADEs) have been identified as a major contributor to preventable hospitalizations and emergency department visits, particularly among the elderly. The IPRO QIN-QIO will provide:

  • An array of analytic processes and interventions that target the high HRMs most frequently associated with preventable ADEs (anticoagulants, antihyperglycemics, antipsychotics, opioid analgesics and antimicrobials).
  • Expertise in antibiotic stewardship initiation/expansion and the prevention of healthcare-associated infections (HAIs).
  • Technical assistance to support serial data collection, analysis, reporting and trending.
  • Facilitated interpretation and root cause analysis to identify priorities for intervention.
  • Evidence-based clinical tools and educational resources for quality improvement interventions, including the incorporation of digital health solutions.
  • Assistance in determining effectiveness of interventions and support innovative strategies that sustain safety goals.
  • Comparative data reports and resources to support the CDC Core Elements of antibiotic stewardship (AS) and education resources for clinicians, staff, patients and residents on antibiotic stewardship.
  • Experience in assessing and determining which Core Elements of AS are in place and/or needed
  • Tools to assess for and implement AS.
  • Networking opportunities with experts in your region and beyond.

What is the Chronic Disease Self-management Program (CDSME) and why is that a focus of the Community of Care Coalitions?
 
This activity features the provision of peer-led self-management workshops designed to build confidence in patients' ability to manage their health and the symptoms related to chronic conditions. Each workshop meets for 2.5 hours, once a week for six weeks. These workshops are facilitated by two peer leaders, trained by IPRO QIN-QIO teams. Participants learn new ways to support their physical, mental and emotional health in a supportive group environment.
 
The original Diabetes Self-Management Program was developed in Spanish. After identifying successful outcomes related to that program, the Stanford Patient Education Research Center received a grant from the California HealthCare Foundation to conduct a randomized, controlled study to test the workshops effectiveness for English-speakers. The study was completed in 2008. Six months after the workshop, participants had significant improvements in depression, symptoms of hypoglycemia, communication with physicians, healthy eating, and reading food labels. They also had significant improvements in patient activation and self-efficacy. At 12 months, DSMP participants continued to demonstrate improvements in depression, communication with physicians, healthy eating, patient activation, and self-efficacy.
 
The Chronic Kidney Disease Awareness and Prevention Program (CKD-APP) was developed from a two-year Special Innovation Project (SIP) that engaged patients, caregivers, and grassroots stake holders with the goals of increasing Chronic Kidney Disease (CKD) awareness among populations most at risk, encouraging timely screenings, promoting efforts to delay disease progression, and supporting strategies that improve patient outcomes. The education sessions of this 6 week workshop series are designed to empower participants through the application of self- management strategies that will help them adopt healthy lifestyle and behavioral modifications that promote improved self - efficacy skills in taking better care of their health.
About Our Contract with the Centers for Medicare & Medicaid Services (CMS)
What authority does the IPRO Quality Innovation Network-Quality Improvement Organization (QIN-QIO) have in working with my organization on quality improvement and data sharing?

CMS contracts with QIN-QIOs to perform core functions relating to quality improvement including, but not limited to, technical assistance, data collection and analysis, quality review studies and stakeholder engagement activities. Applicable statutory and regulatory authorities for the QIO program are codified in Sections 1151-1160 of the Social Security Act (42 USC §§ 1320c-1320c12) and Title 42 of the Code of Federal Regulations.

Under contract to CMS, the IPRO QIN-QIO serves as the QIN-QIO for the New England states, NY, NJ, OH, DE, MD, and the District of Columbia. In this capacity, we are committed to protecting the data collected from your organization for healthcare quality improvement projects. The quality improvement projects that we will work on with your organization are "quality review studies," defined in 42 CFR Section 480.101(b) as "assessment[s], conducted by or for a QIO, of a patient care problem for the purpose of improving patient care through peer analysis, intervention, resolution of the problem and follow-up." Federal regulations, in 42 CFR Section 480.140, mandate confidentiality protections for individual patients, practitioners and institutions that participate in such studies. Accordingly, IPRO QIN-QIO cannot and will not disclose data about participants in a quality review study to any party other than CMS and/or its authorized contractors.