Quality improvement organizations (QIOs) -- Medicare-funded nonprofits that are supposed to make hospital care better -- may not be especially effective. That's the implication of a June 15 study in the Journal of the American Medical Association.

Claire Snyder, a researcher at the Johns Hopkins Bloomberg School of Public Health, reviewed more than 40,000 medical records to determine how often hospitals serving the District, Maryland and four other states met 15 standards of good care. With 1998 data as a baseline, she assessed the hospitals' performance in 2000 and 2001, after the QIOs had been pressing hospitals to meet these standards. By Snyder's analysis, hospitals with the deepest ties to the QIO campaigns had improved on 13 of the 15 indicators, while those with little or no investment in these efforts had improved on 12. In most cases, the difference in improvement rates between the two groups was too small to be statistically significant.

Shared Credit "We found that quality is improving in hospitals regardless of involvement by the quality improvement organizations," Snyder said. "During the time of the study and continuing today, there are a variety of organizations in addition to the QIOs that are creating a climate for quality improvement that is probably affecting hospitals, but the quality improvement organizations are just one part of a whole variety of initiatives."

Since Then Maulik Joshi, CEO of the Delmarva Foundation, the QIO for Maryland and the District, said Snyder's study had methodological flaws and relied on old data. "I think we've evolved a lot over the past few years, and the type of improvement projects QIOs are doing now are really quite dramatic and quite innovative, and really producing terrific results," he said.

The American Health Quality Association (AQHA), the national organization of QIOs, said research based on post-2001 data "shows QIOs are having a significant impact on hospital improvement. This data shows that that hospitals working intensively with QIOs achieved greater improvements in nine of out 10 quality measures than did hospitals that received little or no QIO assistance."

Linda Jaecks, quality manager at George Washington University Hospital, said the QIO-linked efforts made by hospitals have "had a positive, collaborative influence on the entire District." Still, she added, "there's no concrete data to show that the process improvements that [Washington area hospitals are] making . . . ultimately [have] a positive outcome on the patients themselves."

-- Tom Graham