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BACKGROUND/RATIONALE:
The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) are a group of evidence-based measures that use administrative data to screen for potential quality problems in the inpatient and outpatient settings. They represent readily available and low cost measures that may be applied to VA data. They consist of sets of indicators that reflect different aspects of quality and include: the Inpatient Quality Indicators (IQIs) - which measure volume, use and in-hospital mortality associated with specific procedures, plus mortality associated with specific conditions; the Prevention Quality Indicators (PQIs) - which measure hospitalization rates for conditions wherein admissions are potentially avoidable through good outpatient care. Although numerous organizations outside the VA have effectively used the QIs for hospital quality improvement, monitoring trends over time, and public, national, and state reporting, these indicators have received little attention in the VA. Therefore, applying the QIs to VA data presents a unique opportunity to further VA's agenda in quality improvement and patient safety initiatives.
OBJECTIVE(S):
Specific study objectives are to: 1) develop collaborations with key stakeholders who will provide clinical and methodological input and guidance on identifying a set of high-priority QIs for use in VA; 2) apply and modify the AHRQ QI algorithms for use on VA data; 3) investigate the validity of these QIs as indicators of quality; 4) compare QI rates across VA facilities/VISNs; 5) Develop a national quality report and informational guide that facilities can use to understand their QI rates.
METHODS:
This is an observational study using existing national databases. We will obtain input from key VA stakeholders, convened through a steering committee, using a modification of the RAND Appropriateness Method to determine which QI measures are of highest priority for the VA and should be studied further. We will obtain information on VA care from the National Patient Care Database. Since many patients have additional Medicare coverage, we will perform analysis with and without accounting for Medicare use to see how this impacts the frequency of QI events. We will also validate the QIs by examining their association with related measures from the External Peer Review Program and the National Surgery Quality Improvement Program. QI rates will be compared across facilities and to non-VA benchmarks. Additionally, we will develop a national report containing VISN and facility-level reports of QI measures, and an educational guide to facilitate interpretation of results by local managers and clinicians. We will also perform a formative evaluation to identify barriers to use of the report.
FINDINGS/RESULTS:
Preliminary analyses of the Inpatient Quality IQIs has been completed. At the VA and VISN level, rates of death from surgical procedures has been fairly stable over time (FY04 through FY07), while rates of death from medical conditions has been decreasing.
IMPACT:
Our end product will consist of a valid and reliable set of quality measures, relevant and specific to VA's needs and priorities. This will provide an evidence-based set of tools which will complement existing measures by providing a more comprehensive picture of quality in the VA, and will enhance the VA's quality agenda. This project will also foster greater collaboration between researchers and policymakers at various levels, as well as between VA and AHRQ, two federally-funded agencies seeking to improve the quality of care at the national level.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Quality of Care
Keywords:
Quality assessment, Quality assurance, improvement
MeSH Terms:
none
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