|
BACKGROUND/RATIONALE:
VA has been an industry leader in the delivery of high quality medical care. Much of that success has been attributed to strong national leadership, a sophisticated electronic medical record system and the implementation of a performance measurement program. Performance measurement in health care is still in its infancy and as VA aspires to continue to improve the quality of care for its patients, it will be important to determine how to improve these systems so that they support the best possible care. There is speculation that there may be a number of unintended consequences of our current approaches to defining, measuring, and reporting quality. These issues may be especially relevant to the care of complex patients where multiple and sometimes competing performance measures often apply. Yet there is virtually no empirical research documenting the existence of such effects, especially at the level of the patient-clinician encounter. These kind of data are crucial to guide the continued evolution of our quality improvement systems. The purpose of the present study is to determine how the VA's clinical performance measurement system affects the practice of healthcare from the perspective of facility and clinical staff.
OBJECTIVE(S):
The specific objectives of this exploratory study are to develop an in-depth picture of the effects of clinical performance measurement on the VA's systems of care delivery. Utilizing an ecological framework to capture the complex nature of healthcare systems, we will focus our inquiry on four levels within the healthcare system: the intrapersonal level (e.g. staff members' affect, beliefs, and behaviors), the interpersonal level (e.g. the clinical encounter and staff relationships), the clinic and the facility levels (e.g. leadership, culture, and processes). Within each of these levels we will explore current impacts and suggestions for improvement. Specific attention will be paid to the care of complex patients.
METHODS:
This is a qualitative study employing semi-structured individual interviews of staff members at four VA facilities. Interviews will be conducted in person at the participating facilities. In order to obtain a broad range of perspectives on performance measurement, sites will be stratified based on the number of veterans served and facility scores on 2006 performance measures. Within each site we will conduct primary care clinic interviews with physicians, mid level practitioners, and clinic support staff. Leadership interviews will be conducted with the Chief of Staff and/or service line director, quality officers, and primary care clinic directors. We will integrate emergent themes from the interviews into our ecological framework and use this to guide our analysis of interview content into thematic categories, subtopics, and relationships.
FINDINGS/RESULTS:
No findings at this time.
IMPACT:
This study will empirically investigate possible unmeasured effects of the use of performance indicators in healthcare systems. Findings from this work will be organized into a multi-level conceptual model of performance measure impacts. This model will serve as the foundation for research and management initiatives to improve the current performance measurement system.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Quality of Care
Keywords:
Management, Organizational issues, Quality assurance, improvement
MeSH Terms:
none
|
