1. Humphrey, Carolyn J. MS, RN, FAAN

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Under the direction of the Centers for Medicare and Medicaid Services, the Quality Improvement Organizations (QIO) program consists of a national network of 53 QIOs responsible for each US state, territory, and the District of Columbia. These organizations work with home care agencies, physicians, hospitals, consumers, nursing homes, and other caregivers to ensure patients get the right care at the right time, particularly among underserved populations.


The program also safeguards the integrity of the Medicare trust fund by ensuring payment is made only for medically necessary services, and investigates beneficiary complaints about quality of care. All home care agencies should be taking advantage of the vast resources their QIOs have available (


The QIOs in each state have been working actively with home care agencies and state associations to address specific areas of implementation of OBQI. This fall, the Eighth Scope of Work will begin, and the QIOs will expand their activities to focus on helping agencies meet their individual quality goals, especially decreasing acute care hospitalizations.


As an example of a QIO project, this month I want to share an initiative, Quality Insights of Pennsylvania (QIP, the QIO for Pennsylvania), developed to assist clinicians and agencies in meeting an important patient quality indicator-management of oral medications.


The initiative is known as Q-MAP, Quality Medication Administration Project, and promotes best practices for improvement in management of oral medications. Currently, there are 22 home health agencies in Pennsylvania participating in Q-MAP. As part of the project, these agencies will use materials provided by QIP that focus on:


[black small square] Identifying Best Practices related to home health medication management.


[black small square] Selecting staff education tools to help identify specific patient deficits and resources for improvement.


[black small square] Developing Plans of Action to improve patient care.



Using Q-MAP best practice tools, home health clinicians work toward finding the best strategies for improvement for each patient. This process may involve the use of compliance aids, such as pillboxes, various types of medication alarms, telephone reminders, or automated dispensers. Patients also are evaluated for medication simplification-ensuring that patients use the fewest medications possible in the simplest form to achieve the desired treatment goal. A multidisciplinary approach is encouraged.


To determine which strategies are best, agencies and clinicians can use the best practice tools provided by QIP. Q-Map contains a medication assessment protocol, medication nonadherence staff education tool, "Managing your Medicines" self-assessment patient checklist, medication teaching strategies, and medication simplification protocols; Beers criteria for potentially inappropriate medications; selection criteria for medication compliance aids; and an oral medications care planning tool.


In addition to improving patient health, it is anticipated that Q-MAP will decrease costs associated with hospital admissions and emergency care, because as many as one third of emergency care visits and acute care hospitalizations are a result of medication mismanagement.


To integrate best practices and improve your outcomes scores, review the tools and resources from many QIOs and information about the home health quality initiative found at


Also, don't forget to contact your own QIO for any questions or resources you might need to work on your OBQI projects. You can find the contact information for your QIO at and click on the directory under the heading "Topics."


About MedQIC

The Medicare Quality Improvement Community (MedQIC, pronounced med-quick) Web site is sponsored by the Centers for Medicare & Medicaid Services as a national knowledge forum for healthcare and quality improvement professionals ( It provides easy access to quality improvement resources and a community of professionals sharing knowledge and experiences on improving healthcare quality.


All files posted on MedQIC for downloading are in the public domain and are provided for use free of charge. Necessary permissions have already been obtained for any copyrighted materials. Links to tools outside of MedQIC are subject to the host site's policies.