CMS-10294.Appendix G (8-23-10)

APPENDIX G
PARTNER DISCUSSION GUIDE AND LETTER

PARTNER ORGANIZATION
INVITATION LETTER
600 Maryland Ave., SW, Suite 550
Washington, DC 20024-2512
Telephone (202) 484-9220
Fax (202) 863-1763
www.mathematica-mpr.com

[Date], 2010/2011
Contact
Organization name
Street Address
City, ST zip
Dear [contact name]:
This is an invitation to provide important feedback to the Centers for Medicare & Medicaid Services
(CMS) through agreeing to a telephone meeting, roughly 45 to 50 minutes in length, to assist CMS in evaluating
and improving its Quality Improvement Organization Program. The CMS Quality Improvement Organization
Program in this state is operated through [NAME QIO]. As a partner organization in the effort involving
[NAME QIO] to [IMPROVE CARE FOR PEOPLE WITH CHRONIC KIDNEY DISEASE/PREVENT REHOSPITALIZATIONS], the evaluation research team would appreciate your feedback through a telephone
meeting during [TARGET WEEK], to be scheduled at your convenience. You will not need to make any special
preparations for the meeting, and your input will remain confidential to the extent permitted by law. In
particular, we would like to discuss:
•
•
•
•
•

Activities of this organizations in the collaborative effort to [IMPROVE CARE FOR PEOPLE WITH
CHRONIC KIDNEY DISEASE/PREVENT RE-HOSPITALIZATIONS]
Role played by [NAME QIO] in the collaborative effort
Any changes in care resulting from the work of the collaborative effort
Most successful strategies or interventions by the collaborative
Challenges faced and sustainability of the efforts and resulting changes

CMS has contracted with Mathematica Policy Research, Inc. and with Social & Scientific Systems to
conduct the telephone meetings as part of a larger study to evaluate the 9th Scope of Work Quality
Improvement Organization Program. A description of the larger study is attached.
All data collected for the purposes of this study will be combined and reported in aggregate form only.
Neither you nor your organization will be identified by name in any reports or documents produced from the
study findings. Only Mathematica staff that work directly on the evaluation will have access to the name of
your organization and your name.
With your help, the evaluation will provide critical information to CMS to help refine its work to improve
the quality of care. Please see the attached letter of encouragement to participate from CMS. An evaluation staff
member from Social & Scientific Systems will call you to follow up in the next couple of days. In the
meantime, please feel free to call or e-mail [CONTACT INFORMATION OF EVALUATION STAFF
MEMBER] with any questions or to initiate scheduling. Thank you very much in advance for your assistance—
your input into the evaluation is highly valued by CMS.
Sincerely,
Myles Maxfield, Ph.D., Project Director
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this information collection is xxx-XXX. The time required to complete this
information collection is estimated to average 0.8 hours or 48 minutes per response, including the time to review instructions, search existing
data resources, and gather the data needed, and complete and review the information collection. If you have comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports
Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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An Affirmative Action/Equal Opportunity Employer

Chronic Kidney Disease (CKD) and Care Transitions
QIO Partners Discussion Guide

INTRODUCTION
Thank you for agreeing to participate in this interview to better understand the role of the (QIO
name) in working with the community partners on [CKD/CT]. My name is ______________. I
am a researcher with Social & Scientific Systems, a health care research company in Silver
Spring, Maryland. Our organization has received funding from the Centers for Medicare and
Medicaid Services to evaluate the impact of the QIO program on healthcare processes and
outcomes in [CKD/CT]. Our discussion will provide insights on issues related to the work of the
(QIO name) within your community (state).
Your input will remain confidential to the extent permitted by law. All data collected for the
purposes of this study will be combined and reported in aggregate form only. Neither you nor
your organization will be identified by name in any reports or documents produced from the
study findings. Only staff that work directly on the evaluation will have access to the name of
your organization and your name.
Before we begin, are there any questions?
INTERVIEW GUIDE:

QUESTIONS

• TOPIC #1: Activities of the Partner in the Collaborative
CKD Partners: Let’s begin by talking about the role of your organization in the effort to improve the
detection and treatment of CKD.
CT Partners: Let’s begin by talking about the role of your organization in the effort to reduce hospital
readmissions.

1.1

[CKD] Tell me about what your organization is doing as part of the collaborative to
improve the care delivered to people with chronic kidney disease? We’re specifically
interested in activities conducted since summer 2008, both alone and in collaboration
with other organizations.

1.2

[CT] Tell me about what your organization is doing as part of the collaborative to
improve the transition of Medicare patients between care settings in your community, to
help reduce re-hospitalizations? We’re specifically interested in activities conducted
since summer 2008, both alone and in collaboration with other organizations.

1.3

[CKD] Did your work on this collaborative include direct interaction with Medicare
patients with diabetes and their caregivers? [If yes,] Please describe the extent of any
direct interactions.

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1.4

[CT] Did your work on this initiative include direct interaction with Medicare patients
and their caregivers? [If yes,] Please describe the extent of any direct interactions.

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• TOPIC #2: Activities of the QIO in the Collaborative
Next, I’d like to talk about the QIO’s role in the collaborative.

2.1

What were the most important things the QIO did to support the work of the
collaborative?

2.2

To what extent was there significant decision-making by the collaborative as a group,
where participating organizations then carried out actions according to the collaborative’s
decisions?

2.3

[If some decisions were made by the collaborative,] Please describe how decisions were
made among partners in this collaboration? For example, who decided on what the
priorities were?

2.4

What role did the QIO play in decision making?

2.5

Would the activities undertaken by the collaborative likely have occurred if the QIO had
not existed?

2.6

If you were starting over as a group, is there anything you would recommend be done
differently regarding who is in the collaborative, or how it functions?

• TOPIC #3: Changes in Care Resulting from the Work of the Collaborative

3.1

[For provider organizations:] Has your organization made any operational changes that
may affect care, as a result of participating in this initiative? [If yes,] When were these
changes made? [If yes,]Would your organization have made these changes without the
support of the QIO?

3.2

[For organizations other than providers:]Has your organization done anything as a result
of participating in the collaborative that you see as critical to care improvement? [If yes,]
Please describe what you did, and when. [If yes,] Why do you view it as critical to care
improvement? [If yes,] Would your organization have made these changes without the
support of the QIO?

3.3

Thinking about the collaborative as a whole, is there any evidence or anecdotes that
would show actual improvements to patient care as a result of the work of the
collaborative?

3.4

[If yes,] Was the QIO’s role in the collaborative important to producing these changes?
[If yes,] How?

3.5

What if any other efforts have been going on at the same time that could also lead to
[improved care for patients with CKD/fewer re-hospitalizations]?

G.7

• TOPIC #4: Strategies or Interventions that Improve Care
Next, let’s talk about interventions and strategies that have been put in place and how data may have
facilitated your work as part of this initiative thus far.

4.1

What strategies or interventions by the collaborative have been most successful thus
far—either leading to changes in care or most promising for care improvement? Why?

4.2

What strategies or interventions by the collaborative have not worked out to be as
successful as hoped, thus far? Why?

4.3

Tell me about the role the data may have played in identifying specific opportunities for
improvement and the selection of interventions?

4.4

Has your organization, and the collaborative as a whole, had timely access to data to
monitor how effective the efforts have been?

4.5

CKD: annual urinary microalbumin testing, use of ACE inhibitors and ARB drugs,
availability of arteriovenous fistula (AV fistula or AVF) at 1st dialysis

4.6

CT: rehospitalization rates, HCAHPS survey results

4.7

What was the QIO’s role in making the data available to you and the collaborative?

4.8

What have you learned from the data you have reviewed?

4.9

Were modifications made to the strategies/interventions as a result of feedback received
from the data? If so, tell me about these changes and when they occurred.

• TOPIC #5: Challenges and Sustainability
Now, I’d like to talk about the remaining challenges the collaborative faces and sustainability of the
progress that has been made.

5.1

Please describe any important remaining challenges to achieving the goals the
collaborative was established to address.

5.2

What if any plans are underway to address these challenges?

5.3

What will be key factors in whether these challenges can be overcome?

5.4

[If changes in care were reported in Topic #3,] How likely do you think it is that the
changes that have been made thus far will be lasting once the QIO is no longer available
as a resource? Why or why not?

5.5

Are there other group(s) that could assume the role(s) of the QIO?

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5.6

Are there any plans to encourage adoption of any successful strategies tried under this
collaborative elsewhere within the state? Tell me about it.

• Closing
In closing,

I’m hearing that [summarize the respondent’s main point about how successful the collaborative
has been to date]. Do I have that right?
Could you summarize what advice you would have for another group that was starting up
with the goals of the collaborative, about what works well and not so well?
Do you have any advice for CMS as it looks to improve the QIO program’s effectiveness
and efficiency going forward?

G.9