Opportunities to Enhance Value-Related Research in the U.S. Department of Veterans Affairs

Burstin, Helen; Frakt, Austin B.; Krein, Sarah L.; Lorenz, Karl; Maciejewski, Matthew L.; Pizer, Steven D.; Weiner, Michael; Yoon, Jean; Zulman, Donna M.; Asch, Steven M.

doi:10.1007/s11606-015-3538-5

Cited by 2 publications

(1 citation statement)

References 38 publications

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“…Wagner and colleagues highlight findings from the panel on how to measure value, and they make recommendations for future research. 5 Defining value as the incremental outcomes gained per dollar spent, the consensus of the panel was that understanding how to incentivize highvalue care is a top priority for future research. Pay-for-performance (P4P) programs use financial incentives to stimulate improvements in healthcare efficiency and quality.…”

Section: Performance Measures That Enhance Value-related Researchmentioning

confidence: 99%

The Next Generation of Clinical Performance Measures

Atkins

2016

J GEN INTERN MED

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M any are familiar with the adage that Byou can't improve what you can't measure.^Adopting clinical performance measures was an important part of the VA transformation of the 1990s, and measuring clinical performance has become an integral part of current efforts to drive improvement under Medicare, the Affordable Care Act (ACA), and in programs run by private payers. Measuring clinical performance, however, is a health system intervention, and as such, needs to be carefully examined. This includes how measures are created, how they are implemented, and the evidence for their potential benefits and harms. The landscape of healthcare has also changed substantially since the advent of the performance measurement movement, and it is time to update our approach to measuring quality. Rather than setting a single standard, identifying a random number of patients to whom the measure should apply, and conducting manual chart reviews at a single point in time, we need to be assessing quality for the entire population, including the more complex patients. A world with electronic health records and a much richer array of administrative and clinical data allows us to update our approach to include measures that consider population health, episodes of care, changes over time, and individual circumstances. The Department of Veterans Affairs (VA), which operates the largest integrated healthcare system in the United States, is a key contributor to the emerging knowledge base regarding how best to create and implement performance measures.Funded by the VA's Health Services Research and Development (HSR&D) Service, this Journal of General Internal Medicine (JGIM) Supplement is the product of an HSR&D-sponsored state-of-the-art (SOTA) conference titled BNext-Generation Clinical Performance Measures: Patient-Centered, Clinically Meaningful, and High Value,^held in 2014. After the conference, a Call for Papers was issued, and 14 manuscripts were submitted to JGIM. After rigorous JGIM peer review, ten articles were accepted for publication in this special JGIM Supplement. Published papers discuss empirical research on the effects of performance measurement on improvements in clinical care, as well as on unintended outcomes (e.g., inappropriate treatment or over-treatment). Papers also describe new methods and methodological challenges in the selection and creation of performance measures that incorporate measures of benefit and harm, value, or patient preferences, as well as research on the implementation of performance measures that address human factors, incentives and facilitators, barriers, and expected and unintended consequences. USING VA'S ELECTRONIC HEALTH RECORD SYSTEM TO MEASURE QUALITYThree papers examined the ability to use VA electronic data to measure clinical quality in specific clinical areas. Phipps and colleagues developed and validated inpatient stroke electronic clinical quality measures that are part of the Meaningful Use (MU) program and VA efforts to improve inpatient stroke care. 1 The authors found that stro...

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Section: Performance Measures That Enhance Value-related Researchmentioning

confidence: 99%

The Next Generation of Clinical Performance Measures

Atkins

2016

J GEN INTERN MED

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Events Associated With Changes in Reliance on the Veterans Health Administration Among Medicare-eligible Veterans

et al. 2020

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Objectives: We can learn something about how Veterans value the Veterans Health Administration (VHA) versus community providers by observing Veterans’ choices between VHA and Medicare providers after they turn 65. For a cohort of Veterans who were newly age-eligible for Medicare, we estimated the change in VHA reliance (VHA outpatient visits divided by total VHA and Medicare visits) associated with specific events: receiving a life-threatening diagnosis, having a Medicare-paid hospitalization, or moving further from the VHA. Research Design: A longitudinal cohort study of VHA and Medicare administrative data. Subjects: A total of 5932 VHA users who completed a health survey in 1999 and became age-eligible for Medicare from 1998 to 2000 were followed through 2016. Principal Findings: More Veterans chose to rely on the VHA than Medicare (64% vs. 36.%). For a VHA-reliant Veteran, a Medicare-paid hospital stay was associated with a decrease of 7.8 percentage points (pps) (P<0.001) in VHA reliance in the subsequent 12 months, but by 36 months reliance increased to near prehospitalization levels (−1.5 pps; P=0.138). Moving further from the VHA, or receiving a diagnosis of cancer, heart failure, or renal failure had no significant association with subsequent VHA reliance; however, a diagnosis of dementia was associated with a decrease in VHA reliance (−8.6 pps; P=0.026). Conclusions: A significant majority of newly Medicare-eligible VHA users voted with their feet in favor of sustaining the VHA as a provider of comprehensive medical care for Veterans. These VHA-reliant Veterans maintained their reliance even after receiving a life-threatening diagnosis, and after experiencing Medicare-provided hospital care.

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Opportunities to Enhance Value-Related Research in the U.S. Department of Veterans Affairs

Cited by 2 publications

References 38 publications

The Next Generation of Clinical Performance Measures

The Next Generation of Clinical Performance Measures

Events Associated With Changes in Reliance on the Veterans Health Administration Among Medicare-eligible Veterans

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