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BACKGROUND/RATIONALE:
Background/Rationale: How well the VHA does in caring for veterans with CHC is not clear. The scant available data evaluating the quality care in CHC indicate systematic deficiencies in how care is provided among veterans. Given these data, quality improvement efforts are needed in CHC. However, several key tasks need to be accomplished before such efforts can be initiated. These include development of a quality assessment tool in CHC, evaluation of the degree and sources of deviation from best practices, and development of potential quality improvement interventions in CHC.
OBJECTIVE(S):
Objectives: In need of understanding and correcting deviations in CHC quality, we identified an explicit set of quality indicators (QIs) in CHC using the RAND/UCLA Appropriateness Method. With these QIs, our research has the following objectives: (1) operationalize expert panel derived QIs into electronic data and chart review abstraction algorithms; (2) determine the rate of adherence to selected QIs by estimating the proportion of eligible patients receiving indicated care in an analysis of existing national VA HCV Registry; (3) validate the rate of adherence derived from HCV Registry against the rate of adherence derived from patient chart reviews in a sample of 1200 CHC patients in 4 VA facilities; and (4) identify predictors of adherence to QIs at patient (e.g., demographics, liver disease severity, comorbidity), provider (e.g., experience, specialty), and facility (e.g., capacity, primary care characteristics, specialty care characteristics) levels.
METHODS:
Methods: The study will be conducted in 4 steps corresponding to 4 specific aims. For aim 1, we will define the exclusion/inclusion criteria and identify data elements for the selected QI. For aim 2, we will analyze the national HCV registry data which includes extensive health related information on > 250,000 veterans with CHC. We will determine the proportion of patients who were eligible for and who received care indicated by each QI (i.e., determine level of adherence). For aim 3, we will conduct chart reviews of random sample of 300 patients at each of the 4 study sites to validate and improve our algorithm for identifying QI in the HCV Registry. We will use the refined algorithms to describe the level of adherence to the QIs at the national level. We will also evalutate the predictive validity of QIs by measuring the relationship between quality scores and a patient outcome, i.e., sustained viral response. For aim 4, we will conduct multivariable logistic regression analyses to determine patient, provider, and facility-level predictors of adherence to each QI. These data will guide strategies for quality improvement at facility or individual patient-provider level in CHC.
FINDINGS/RESULTS:
No findings at this time.
IMPACT:
Anticipated Impacts on Veterans' Healthcare: We propose to develop a structured quality assessment tool in chronic hepatitis C (CHC) capturing relevant domains of CHC care among veterans and to identify the key modifiable determinants of high quality care. These data will be translated into quality improvement efforts to improve overall care in veterans with CHC. In addition to its potential impact on patient care, our project will render explicit quality measures for performance benchmarking in CHC care.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems, Special (Underserved, High Risk) Populations
DRE:
Epidemiology, Quality of Care, Diagnosis and Prognosis
Keywords:
Quality assessment, Utilization patterns, Hepatitis C
MeSH Terms:
none
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