Disseminating a Dashboard for VA Purchased Community Nursing Homes

 描述(由申请人提供)： 背景：退伍军人事务部负责监督和规划为符合条件的退伍军人购买的以社区为基础的疗养院(CNH)护理，每年花费8.1亿美元。CNH设施的选择、合同和质量监督由当地的VAMC执行。VAMC或VISN的CNH质量标志对GEC领导层来说并不容易获得。GEC数据和分析中心(GEC DAC)为购买的CNH质量开发了一个仪表盘。CNH仪表板比较了医疗保险和医疗补助服务中心(CMS)对VAMC购买护理(观察)的CNH设施的五星级排名与周围社区(预期)的非合同CNH设施的比率。对这一观察到的与预期的比率(O/E)的初步分析表明，在CMS的五星级排名中，购买了CNH护理的退伍军人管理局的表现通常低于未签订合同的CNH设施(平均O/E为0.86±0.17)，并且VAMC设施之间存在很大的差异(O/E范围为0.32至1.31)。O/E总结了CMS针对所有CNH住院患者的五星级排名，而不仅仅是退伍军人。从退伍军人的角度来看，CNH质量的最终衡量标准是在退伍军人特定的水平上确定护理质量。因此，了解和提高CNH工艺的质量有很大的机会。目标：这项提案的首要目标是改善退伍军人在购买的CNH设施中接受的护理质量。为了实现这一目标，本建议有三个目标：目标1)通过检查购买的CNH选择过程来了解质量测量的作用，目标2)评估CNH仪表板的实施对退伍军人购买的CNH护理相对于其他CNH设施的质量的影响，以及目标3)通过从退伍军人特定的CMS数据得出的过渡和安全结果度量来评估购买的CNH设施中的退伍军人特定护理的质量。方法：我们将通过对合同官员和GEC领导进行半结构化访谈，绘制CNH选择、合同签订和监测的过程。我们将以随机、阶梯楔形传播的方式评估CNH Dashboard发布的效果。这一传播设计使我们能够比单一阶段的推出更系统地确定CNH仪表板对购买的CNH设施的质量的影响。在这4个步骤中的每一个步骤中，我们都会将CNH控制面板发布到随机选择的一组VISN。一项旨在解决CNH选择过程差距的教育计划将伴随CNH Dashboard发布。最后，我们将通过获取退伍军人在退伍军人医院的详细质量和结果CMS数据来评估退伍军人在退伍军人医院的护理质量。研究结果：目前，退伍军人管理局购买的CNH护理在CMS五星级排名系统中的质量低于VAMC市场上的其他CNH设施。CNH仪表板向GEC的地方、地区和国家各级领导人提供了可操作的信息，将提高CNH护理的质量。状态：这个为期两年的项目由退伍军人事务部波士顿老年病学家詹姆斯·鲁道夫博士领导，他成功地实施了创新的质量项目。GEC办公室是该项目的合作赞助商，该项目的实施需要由Orna Intrator博士领导的GEC DAC的大力支持。GEC DAC指导委员会将对该计划的进展进行监督。影响：该计划完成后，将提高退伍军人在退伍军人管理局购买的CNH计划中接受的护理质量，这体现在对CNH设施的选择和退伍军人特有的措施上。

 DESCRIPTION (provided by applicant): Background: The VA Office of Geriatrics and Extended Care (GEC) is responsible for the oversight and planning of purchased Community-based Nursing Home (CNH) care for eligible Veterans at an annual cost of $810 Million. The selection, contracting, and quality oversight of CNH facilities is performed at the local VAMC. Markers of CNH quality for a VAMC or VISN are not readily available to GEC leadership. The GEC Data and Analyses Center (GEC DAC) has developed a dashboard for purchased CNH quality. The CNH Dashboard compares the ratio of the Centers for Medicare and Medicaid Services (CMS) 5-star rankings for CNH facilities where the VAMC purchases care (observed) to the non-contracted CNH facilities in the surrounding community (expected). Preliminary analyses of this observed to expected ratio (O/E) measure demonstrate that VA purchased CNH care generally performs lower on CMS's 5-star ranking than non- contracted CNH facilities (mean O/E 0.86 ±0.17) and there is substantial variability across VAMC facilities (O/E range 0.32 to 1.31). The O/E summarizes the CMS 5-star rankings for all CNH residents, not just Veterans. From the VA perspective, the ultimate measure of quality in CNH is to determine, on a Veteran specific level, the quality of care. Thus, there is significant opportunity for understanding and improving the quality in CNH process. Objectives: The overarching goal of this proposal is to improve the quality of care Veterans receive in purchased CNH facilities. To achieve this goal, this proposal has three objectives: Objective 1) to understand the role of quality measurement by examining the purchased CNH selection process, Objective 2) to evaluate the impact of the CNH Dashboard implementation on the quality of VA Purchased CNH care relative to other CNH facilities, and Objective 3) to evaluate the quality of Veteran-specific care in purchased CNH facilities by transition and safety outcome measures derived from Veteran-specific CMS data. Methods: We will map the process of CNH selection, contracting, and monitoring by conducting semi- structured interviews with contract officials and GEC leaders. We will evaluate the effect of the CNH Dashboard release in a randomized, stepped-wedge dissemination. This dissemination design allows us to determine the impact of the CNH Dashboard on the quality of purchased CNH facility more systematically than a single phase roll-out. In each of the 4 steps, we will release the CNH Dashboard to a randomly selected set of VISNs. An educational program designed to address the process gaps of CNH selection will accompany the CNH Dashboard release. Finally, we will evaluate the quality of care of Veterans in VA- purchased CNH by capturing detailed quality and outcomes CMS data on Veterans in CNH. Findings: Currently, the VA is purchasing CNH care that is of lower quality on the CMS 5-star ranking system than other CNH facilities in the VAMC market. The CNH Dashboard has actionable information to leaders in GEC at the local, regional, and national levels that will improve the quality of CNH care. Status: This two year program is led by Dr. James Rudolph, a VA Boston geriatrician, who has successfully implemented innovative quality projects. The Office of GEC is the partnered sponsor for this project and the implementation involves substantial support from the GEC DAC, led by Dr. Orna Intrator. The GEC DAC Steering committee will provide oversight for the progress of this program. Impact: When completed, this program will improve the quality of care Veterans receive in VA purchased CNH programs as demonstrated by improved selection of CNH facilities and Veteran-specific measures.