This study determined how extensively Quality Improvement Organizations (QIOs) identified quality-of-care concerns through medical record reviews and what interventions they took in response to confirmed concerns. QIOs comprise medical professionals working with health care providers on quality improvement initiatives and reviewing medical records to ensure that care meets professional standards. QIOs review medical records for quality, payment, utilization, or non-coverage concerns. Researchers analyzed QIO-reported case review data for all cases that QIOs selected for review between 2003 and 2006. Researchers reviewed documentation and interviewed staff from three QIOs.
QIOs recommended corrective actions in about 4,500 of the over 300,000 cases initially selected for review during the study period. QIOs reviewed for quality of care about 11 percent of the cases, confirmed a quality concern in about 19 percent of these reviewed cases, and recommended corrective actions in 72 percent of the cases with a confirmed quality concern. This amounted to 1.5 percent of the cases reviewed.
Report Title: Quality Concerns Identified Through Quality Improvement Organization Medical Record Reviews, http://oig.hhs.gov/oei/reports/oei-01-06-00170.pdf
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact: Claire Barnard, 202-205-9523
Performer: Office of Inspector General
PIC ID: 8776