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Costs and Outcomes of Chronic Heart Disease Care in the VHA

VHA 中慢性心脏病护理的成本和结果

基本信息

批准号：
9015267
负责人：
PETER W. GROENEVELD
金额：
--
依托单位：
PHILADELPHIA VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-02-01 至 2018-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9015267
关键词：
Address Address Administrator Administrator American Hospital Association American Hospital Association Cardiology Cardiology Cardiovascular Diseases Cardiovascular Diseases Cardiovascular system Cardiovascular system Caring Caring Cause of Death Cause of Death Characteristics Characteristics Chronic Chronic Clinical Clinical Congestive Heart Failure Congestive Heart Failure Cost Control Data Data Databases Databases Decision Support Systems Decision Support Systems Devices Devices Diagnosis Diagnosis Economic Inflation Economics Economics Enrollment Enrollment Event Event Face Face Fees Fees Frequencies Frequencies Goals Goals Growth Growth Health Health Health Benefit Health Care Costs Health Care Costs Health system Health system Healthcare Healthcare Heart Diseases Heart Diseases Hospitalization Hospitalization Hospitals Hospitals Housing Imaging Techniques Imaging Techniques Information Resources Information Resources Interview Interview Knowledge Knowledge Leadership Leadership Linear Models Linear Models Measures Measures Medical Medical Medical center Medical center Medicare claim Medicare claim Medicine Medicine Methodology Methodology Myocardial Ischemia Myocardial Ischemia Neighborhoods Neighborhoods Outcome Outcome Outcome Study Outcome Study Patient Care Patient Care Patients Patients Pattern Pattern Performance Performance Pharmaceutical Preparations Pharmaceutical Preparations Plant Roots Plant Roots Policies Policies Process Process Provider Provider Qualitative Research Qualitative Research Quality of Care Quality of Care Reporting Reporting Research Research Research Methodology Research Methodology Research Personnel Research Personnel Research Project Grants Research Project Grants Resources Resources Risk Risk Series Series Source Source Standardization Statistical Data Interpretation Structure Structure Surveys Surveys Survival Rate Survival Rate Technology Technology Telephone Telephone United States Centers for Medicare and Medicaid Services United States Centers for Medicare and Medicaid Services Veterans Veterans base base cardiovascular imaging cardiovascular imaging care costs care outcomes comparative comparative cost cost cost outcomes data warehouse design design dissemination research dissemination research economic outcome experience experience health administration health administration implantable device implantable device improved improved improved outcome improved outcome mortality multidisciplinary new technology operation operation patient population patient population pressure pressure prevent prevent programs programs provider networks research data dissemination theories theories

项目摘要

DESCRIPTION (provided by applicant): Cardiovascular disease is the leading cause of death among veterans enrolled in the Veterans Health Administration (VHA), and it is also a major component of the VHA's operating costs. In recent years, VHA has undertaken numerous quality-of-care initiatives to improve health outcomes in patients with heart disease. Simultaneously, fiscal pressures on VA's clinical operations have increased, and the VHA's is increasingly compelled to optimize the value of its health care (i.e., improve outcomes while conserving limited resources). While VHA continuously collects and reports numerous process-of-care quality measures to assess clinical performance across VA medical centers (VAMCs), there is much less known about cardiovascular outcomes and costs of care at the VAMC level. This absence of information prevents VHA leadership from having a clear picture of the comparative performance of VAMCs in providing high-quality cardiovascular care that maximizes value. Our multi-disciplinary team of highly experienced investigators in cardiovascular outcomes and economics proposes to compare the outcomes and costs of care for two widely prevalent and high-cost cardiovascular conditions-ischemic heart disease (IHD) and chronic heart failure (CHF)-across the VA's 150 VAMCs from fiscal year 2010 to 2014. The specific aims of the research project are: (1) to identify the VAMCs that consistently produced excellent risk-adjusted health outcomes for veterans with IHD and CHF during this five-year period and quantify the costs of care associated with producing these outcomes; (2) to identify and quantify the structural aspects of CHF/IHD care at these VAMCs that are most conducive to optimal outcomes and economic efficiency, with a particular focus on the influence of the local frequency of several high-cost components of care, including: cardiovascular imaging, implantable device utilization, off-station major cardiovascular care, and non-elective hospitalizations; and (3) to explore in depth the key clinical, programmatic, and leadership, and factors that produced these outcomes via interviews with the leadership and clinical providers at that nation's top-performing and low-performing VAMCs. To address these research aims, we will combine data from the VA's National Patient Care Databases, the VA's Decision Support System National Data Extract databases, and the VA's Fee Basis Care Database-all housed at the VA's Corporate Data Warehouse. Additional data will be obtained from the American Hospital Association's Annual Hospital Survey and from the VA/Centers for Medicare and Medicaid Services data available from the VA Information Resource Center. Multivariable statistical analyses using hierarchical generalized linear models will be conducted to investigate hospital-level outcomes and costs of cardiovascular care while controlling for key differences across VAMCs in their CHF and IHD patient populations. We will follow this quantitative analysis with a qualitative assessment of information collected in a series of telephone-based interviews with administrative and clinical leadership as well as front-line clinicians at the top 5 VAMCs and bottom 5 VAMCs in terms of cardiovascular care value. This "grounded theory" qualitative analysis will identify the key institutional, programmatic, and leadership factors that characteriz the nation's top-performing VA Medical Centers (VAMCs) in high-value IHD and CHF care, providing a critical blueprint to VA clinical and operations leaders seeking to improve cardiovascular care throughout the VA's health system. Our results subsequently will be communicated to key policy and clinical leaders in VA cardiology via the provider networks maintained by the VA's Chronic Heart Failure and Ischemic Heart Disease Quality Enhancement Research Initiatives (QUERIs), whose leaders will partner with the project's research team as co-investigators in the design and conduct of the study, as well as the dissemination of the research results.