Clinical study
The association between quality improvement activities performed by managed care organizations and quality of care

https://doi.org/10.1016/j.amjmed.2004.02.046Get rights and content

Abstract

Purpose

Little data are available to assess the efforts of managed care organizations to improve quality of care. This analysis assessed differences in performance rates between organizations with and without quality improvement activities.

Methods

We reviewed 399 self-reported quality improvement activities submitted by organizations seeking accreditation by the National Committee for Quality Assurance. Processes or outcomes assessed in quality improvement activities were linked to corresponding measures in the effectiveness-of-care database of the Health Plan Employer Data and Information Set (HEDIS). Performance rates for managed care organizations with and without quality improvement activities were then compared.

Results

The cross-sectional analysis included 79 quality improvement activities from 50 organizations, covering 12 effectiveness-of-care categories. Each activity had a matching performance score in the database. Financial incentives for providers were associated with substantially higher performance rates in organizations employing this type of intervention. Eight effectiveness-of-care categories had at least four organizations reporting specific quality improvement activities for the care category of interest; statistically significant improvements were observed for follow-up visits for patients after hospitalization for mental illness, checkups after delivery, and screening for cervical cancer.

Conclusion

Based on objective and audited information, the estimated effects of self-reported quality improvement activities were often small and inconsistent. In some instances, the observed effect was contrary to the expected direction. Limitations of the available dataset and the caveats of a cross-sectional study design precluded a number of analytical options. Longer-term, prospective studies are needed to explore further the relation between quality improvement activities and objective measures of clinical performance.

Section snippets

Initial selection of quality improvement activity programs

We selected quality improvement activities for organizations receiving an accreditation status of “excellent”, “commendable”, or “accredited” from the National Committee for Quality Assurance. An “excellent” or “commendable” status indicates that the organization met all the accreditation requirements for consumer protection and quality improvements and has standard quality measure scores in the highest range of national performance. An “accredited” status is given to organizations that meet

Results

Of 399 quality improvement activities evaluated, 79 (19.8%) had at least one measure that could be matched to a corresponding effectiveness-of-care category score for the same managed care organization during the same time period (Appendix 3 at www.zynx.com/research/ncqa_appendices.htm depicts the flow of identifying the quality improvement activities). All quality improvement activities were implemented at least 22 months (median, 36 months) before measurement of the performance score.

Discussion

Improving the quality of health care in the United States is challenging. The effectiveness of potential solutions, such as quality improvement programs initiated by managed care organizations, may vary widely. We hypothesized that a formal quality improvement activity should lead to demonstrable differences in objective quality measures. Thus, organizations with activities targeted at improving rates of mammography screening should, on average, have better rates than organizations without such

Acknowledgements

We thank L. Gregory Pawlson, MD, MPH, and Sarah Shih, MPH, from the National Committee for Quality Assurance, Washington, D.C., for their important contributions to this project.

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This investigator-initiated work was partially supported by a research grant from TAP Pharmaceutical Products, Inc., Lake Forest, Illinois.

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