In This Issue

Director's Letter

Director's Letter
by David Atkins, M.D., M.P.H., Acting Director, HSR&D

In the late 1990s, the VA was ahead of most health care organizations in incorporating a robust set of quality measures as part of sweeping reforms. Some 15 years later, the VA is once again leading— this time in applying health services research to document the limitations of many widely used measures...

Commentary

Quality Measurement and the Ubiquitous Electronic Health Record
by Joseph Francis, M.D., M.P.H., Office of Informatics and Analytics, VA Central Office, Washington, D.C.

Now that VA is well into its second decade of using quality measures and EHRs to guide its care of Veterans, the constraints of this approach are becoming more apparent...

Response to Commentary

Moving toward a Patient-centered Performance Management System
by Eve A. Kerr, M.D., M.P.H., and Rodney A. Hayward, M.D., both with the VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan

VA has the opportunity to move beyond those first step measures and develop a performance management system to help guide optimal patient-centered care—a system that takes into account the risks and benefits of tests and treatments for individual Veterans...

Research Highlights

Validating the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators: How Well Do They Identify True Safety Events?
by Amy K. Rosen, Ph.D., Center for Organization, Leadership, and Management Research (COLMR), VA Boston Healthcare System, Boston, Massachusetts

Ensuring patient safety, "freedom from accidental injury caused by medical care," is a high priority for the VA. A formal patient safety program was launched in 1997, promulgating the VA as a national leader in patient safety...

Performance Measure for Heart Failure Care
by Paul Heidenreich, M.D., M.S., Center for Healthcare Evaluation, Chronic Heart Failure QUERI, VA Palo Alto Healthcare System, Palo Alto, California

In a demonstration of its commitment to quality, the VA has provided data to the Centers for Medicare and Medicaid Services (CMS) so that CMS can report publically available comparisons of outcome and process measures for heart failure care to similar data from Medicare hospitals...

Improving Health Care for Veterans by Improving Health Care Quality Measures
by Alex Sox-Harris, Ph.D., Center for Health Care Evaluation and Substance Use Disorder QUERI, VA Palo Alto Health Care System, Palo Alto, California

The health care that Veterans receive can be substantially improved by implementing validated health care quality measures because they define and motivate guideline-congruent care, reveal gaps in the continuum of care, and identify high-and low-performing facilities so that quality improvement efforts can be targeted...

Are Financial Incentives to Health Care Providers Effective? Evidence from the Field
by Laura Petersen, M.D., M.P.H., Houston Center for Quality of Care and Utilization Studies, Houston, Texas

Why might financial incentives work to improve guideline adherence? Financial incentives for individual effort and task performance might amplify the positive effects of educational interventions and goal-setting performance feedback reports...