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BACKGROUND/RATIONALE:
VA is considered to be a national leader in performance measurement. However, current VA performance measurement may not be keeping pace with this reputation for several reasons. VA methods are based upon reviews of small samples of patients that may not accurately reflect performance at the facility level. Furthermore, VA performance measures are primarily cross-sectional snapshots of care that may not accurately reflect the dynamic, longitudinal nature of primary care for chronic conditions. Lastly, the majority of VA performance measures do not provide information that readily lends itself to action to improve quality. If VA is to remain on the leading edge of improving health care for veterans through continuous feedback of valid, accurate, actionable, and timely performance measures, VA must continue to innovate and to lead the field in the science of performance measurement and benchmarking.
OBJECTIVE(S):
The goal of this study is to build upon prior work on developing the methods for VA facility performance measurement for diabetes mellitus care that will avoid the need to extrapolate performance from samples of patients, will reflect state-of-the-art measures for chronic disease, and will provide actionable information at the facility level for all VA networks. We will use our recently-developed performance measure that incorporates response to an inadequately controlled hemoglobin A1C value. We will identify the proportion of veterans with diabetes who achieve guideline-recommended levels of glycemic control (defined as A1C < 7%) or who receive appropriate follow-up care if A1C levels are not adequately controlled at the VA facility level. We will use our previously developed VA peer facility groupings to compare VA facility performance for diabetes care. Lastly, we will determine the effect of excluding certain patients, such as those with limited life expectancy or risk factors for poor glycemic control, on facility-level performance measures for diabetes.
METHODS:
Our study cohort will include veterans with diabetes utilizing primary care from 10/1/2006 to 9/30/2007 (FY 2007). Veterans will be identified as having diabetes if they have any of the following documented in the study interval or one year prior in the VA National Patient Care Database or the VA fee-basis files: two outpatient diagnoses codes or one inpatient diagnoses code indicating diabetes, filled prescription of diabetes medication, or at least two blood glucose readings >/= 200 mg/dL at least one day apart. Using valid and available data sources, we will collect for each diabetic patient the clinical indicators that have been reported to influence glycemic status and overall diabetes care. We will benchmark VA facility performance against appropriate peers.
FINDINGS/RESULTS:
We are reviewing our cohort identification methods to determine the proportion of veterans with diabetes who achieved guideline-recommended levels of glycemic control and the proportion who received appropriate follow-up care when A1C levels were not adequately controlled. Major activities in progress since the start of the project include a literature review and identification of diagnoses codes for conditions leading to limited life expectancy and acquiring of FY 2007 administrative data to identify the study cohort.
IMPACT:
Our study has the potential to inform and improve the VAs overall performance measurement and benchmarking efforts for chronic disease care and to keep VA at the forefront of such efforts to measure and improve the quality of health care for veterans and the nation.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care
Keywords:
Diabetes, Quality assessment
MeSH Terms:
none
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