QUERI – Quality Enhancement Research Initiative

Ensuring Quality and Care Coordination in the Era of Veterans Choice

Ann Arbor, MI

Overview:

Providing appropriate healthcare means ensuring that patients get the care they need while avoiding care that is unnecessary or harmful. Beginning in the 1990s, VA focused on increasing the use of necessary services through a performance management system that resulted in a dramatic decrease in the underuse of necessary VA healthcare services. Today, there is growing interest in also identifying and reducing overuse - care that exposes patients to services that may not be beneficial or may cause harm, and which may take scarce resources away from those who would benefit most from them. The appropriateness of this care extends not just to clinical processes, but also to care experiences, especially with access, continuity, and coordination. Moreover, if Veterans are to increasingly receive care by non-VA providers via the Veterans Choice Act (VCA), it is imperative that methods be developed to identify, prioritize, and track care in both VA and non-VA settings in order to ensure Veterans continue to get excellent and appropriate care.

Objectives:

The QUERI project will target the following aims.

• Identify and prioritize measures of underuse and overuse relevant to the Veterans Choice Act, which will include:
• Developing a prioritized list of 8 clinical areas, relevant to the VCA, which should be monitored;
• Identifying potential quality measures of overuse and underuse in these 8 clinical areas, and convening an expert panel to rate each measure (or recommendation) on its validity/importance, improvement opportunity, and measurement feasibility.
• Assess the use of existing and non-VHA data sources to evaluate quality of care for VCA users, which will include:
• Determining the availability and reliability of laboratory and pharmacotherapy information for Veterans receiving non-VA care, including care under VCA.
• Developing and testing an interactive voice response approach for collecting outcomes to allow outcome-based measurement of Veterans' depression care.
• Identify areas of importance to Veterans with respect to access, continuity, and coordination, which will include:
• Engaging patients in a deliberative consensus-oriented decision-making process to identify areas of importance to Veterans with respect to access, continuity, and coordination.

Methodology:

This project will use a systematic approach to:

• Identify and prioritize measures of underuse and overuse relevant to the Veterans Choice Act;
• Assess the use of non-VA data sources to evaluate quality of care, including patient-reported outcomes; and
• Identify existing items (or need for new items) that assess areas that Veterans find important with respect to access, continuity, and coordination.

This project also will:

• Develop reproducible methods to identify and prioritize measures that track appropriateness of care;
• Evaluate the potential and challenges of reliably using non-VA data for quality assessment; and
• Identify important areas for further tracking Veteran experiences.

This work will lay a critical foundation for future systematic assessments of quality of care for Veterans who use VCA options, so that VA can ensure improvements in access for areas that Veterans care about, while maintaining coordination and high levels of quality.

Operations Partner: VA Office of Clinical Analytics and Reporting.

Principal Investigator: Eve Kerr, MD, MPH; contact at Eve.Kerr@va.gov .