PRIS-M: Precision Monitoring to Transform Care

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 DESCRIPTION (provided by applicant): Background and Specific Aims The VHA is unquestionably a leader in use of electronic health record (EHR) data to inform clinical, operational, and administrative decisions. Despite the growing granularity and accessibility of these data, however, data are currently most commonly used to retrospectively evaluate quality of care rather than to provide the right data at the right time to the right person in a way that increases patient and staff satisfaction and improves healthcare outcomes. The Precision Monitoring (PRIS-M) to Transform Care program meets this critical need as it aims to: 1) Implement and evaluate electronic clinical quality measures (eCQMs) and decision support tools at the point of care; 2) Conduct scalable clinical quality improvement projects that link electronic data to provider actions and reporting; 3) Investigate the effects of providing actionable EHR-based data on care team and Veteran behaviors and satisfaction; and 4) Identify the implementation strategies and contextual factors that activate VHA providers, leaders, and Veterans to use data to transform care. Methods With the ongoing input of our core partners, these aims will be accomplished via core research and quality improvement projects that cover multiple conditions and care settings. Our projects focus on: 1) national implementation of inpatient eCQMs, 2) testing telehealth modules and eCQMs for improving rapid transient ischemic attack (TIA) care, 3) decision support to deimplement inappropriate carotid ultrasound image ordering, and 4) a local quality improvement project to implement and evaluate a remote sleep apnea monitoring program. In addition, the PRIS-M program includes two additional projects: one to implement and evaluate the first Emergency Department Clinical Pathway decision support tool (acute stroke care) being rolled out to facilities in January 2016, and one to implement a local program of electronic documentation and display of patient behavior change goals to improve coordination and satisfaction with care. These projects are supported by an Implementation and Data Core that works across all projects to facilitate efficient use of data; usability testing of new tools; and standardized use f implementation measures, methods, and analytic approaches. Our overarching implementation strategy focuses on activating individuals and groups to use data to transform care, and we use the CFIR framework to plan data collection and analyses across projects to identify core implementation strategies and contextual factors that impact how people use data to transform care. Key partners include OIA/OABI, the Office of Specialty Care, the National Center for Health Promotion and Disease Prevention, the Office of Telehealth, the Roudebush VAMC, and the VA Center for Applied Systems Engineering. Anticipated impacts The PRIS-M Program directly addresses the Blueprint for Excellence Strategy Three: Leverage information technologies, analytics, and models of healthcare delivery to optimize individual and population health outcomes. Our projects lead directly to the implementation and evaluation of tools that will be useful across all VHA facilities and multiple clinical conditions and settings. We also wil address the important implementation questions about how best to use data to activate providers, healthcare teams, and Veterans to improve healthcare delivery and outcomes. In total, this program will provide multiple new proven tools and strategies for VHA to use as it leads the nation in leveraging its data systems to transform care.