ized performance measures for use in a variety of settings for medication management of atrial fibrillation, congestive heart failure, coronary artery disease, diabetes, dyslipidemia, hypertension, and post–myocardial infarction (Fleming, 2001).

As part of the QIO Seventh Scope of Work (see Chapter 4), CMS developed a home care demonstration project to test the Outcomes-Based Quality Improvement Technology, a systematic approach to measuring outcomes and targeting care processes that require improvement in home health agencies. This technology enables the QIOs to work with individual home health agencies to identify areas in which outcomes across the patient census are substandard, identify provider-specific causes of poor outcomes, and compare the practices of the home health agency with a clinical synthesis of best practices. Expanded to a pilot project in five states, the Outcomes-Based Quality Improvement Technology collaboration operates with a 67 percent participation rate by home health agencies (Thoumaian, 2002).

In addition to these major demonstration initiatives, the Health Care Quality Improvement Program, implemented by the QIOs, formulates evidence-based performance measures for use in its initiatives, primarily in Medicare, to improve care. The QIO Support Centers project engages in a synthesis of the clinical literature around targeted conditions as the foundation for developing quality indicators (Centers for Medicare and Medicaid Services, 2002).

Substantial attention has been directed toward enabling better public disclosure of quality information. CMS has worked collaboratively with AHRQ to develop Medicare applications of CAHPS and is continuing research on how to format the results more effectively for beneficiaries. Assessing how better to engage beneficiaries in the public disclosure elements of quality oversight provides a focus for Medicare CAHPS-related research. Accordingly, CMS has developed a research agenda aimed at exploring beneficiaries’ readiness to use comparative information and at tailoring information to the decision-making processes actually employed by users (McPhillips, 2002).

CMS has devoted particular attention to developing tools for public disclosure of comparative quality data for nursing homes. It began a six-state demonstration project in January 2002 to collect and publish quality information on nursing homes in Colorado, Florida, Maryland, Ohio, Rhode Island, and Washington. The data are based on performance measures developed through public–private collaboration by CMS, the industry, consumer representatives, and the National Quality Forum. The data collected were published in April 2002. The pilot is testing alternative approaches for public disclosure of data to determine which approaches

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