title: From adversary to partner: have quality improvement organizations made the transition?
abstract: OBJECTIVE
  To describe the perceived impact of the Centers for Medicare and Medicaid Services Quality Improvement Organizations (QIOs) on quality of care for patients hospitalized with acute myocardial infarction, in the context of new efforts to work more collaboratively with hospitals in the pursuit of quality improvement.
  
  
  METHODS
  Primary data collected from a national random sample of 105 hospital quality management directors interviewed between January and July 2002.
  
  
  METHODS
  We interviewed quality management directors concerning their interactions with the QIO interventions, the helpfulness of QIO interventions and the degree to which they helped or hindered their hospital quality efforts, and their recommendations for improving QIO effectiveness.
  
  
  RESULTS
  More than 90% of hospitals reported that their QIO had initiated specific interventions, the most common being the provision of educational materials, benchmark data, and hospital performance data. Many respondents (60%) rated most QIO interventions as helpful or very helpful, although only one-quarter of respondents believed quality of care would have been worse without the QIO interventions. To increase QIO efficacy, respondents recommended that QIOs appeal more directly to senior administration, target physicians (not just hospital employees), and enhance the perceived validity and timeliness of data used in quality indicators.
  
  
  CONCLUSIONS
  Our study demonstrates that the QIOs have overcome, to some degree, the previously adversarial and punitive roles of Peer Review Organizations with hospitals. The generally positive view among most hospital quality improvement directors concerning the QIO interventions suggests that QIOs are potentially poised to take a leading role in promoting quality of care. However, the full potential of QIOs will likely not be realized until QIOs are able to engender greater engagement from senior hospital administration and physicians.
authors.affiliation: Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06520-8034, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Melissa D A
authors.initials: MD
authors.lastname: Carlson
authors.forename: William T
authors.initials: WT
authors.lastname: Gallo
authors.forename: Jeanne
authors.initials: J
authors.lastname: Scinto
authors.forename: Miriam K
authors.initials: MK
authors.lastname: Campbell
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D001291:Attitude of Health Personnel; D019985:Benchmarking; D014487:Centers for Medicare and Medicaid Services, U.S.; D003430:Cross-Sectional Studies; D006293:Health Promotion / Q000592:standards / Q000706:statistics & numerical data*; D006740:Hospital Administrators / Q000523:psychology; D006761:Hospitals / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D009936:Organizational Innovation; D008486:Physician Executives / Q000523:psychology; D011366:Professional Review Organizations; D019984:Quality Indicators, Health Care; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology