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

• 批准号: 9888301
• 负责人: PETER W. GROENEVELD
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 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/9888301
• 关键词: Address; Administrator; American Hospital Association; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Characteristics; Chronic; Clinical; Congestive Heart Failure; Data; Databases; Decision Support Systems; Devices; Diagnosis; Economics; Enrollment; Event; Face; Fees; Frequencies; Goals; Growth; Health; Health Benefit; Health Care Costs; Health system; Healthcare; Heart Diseases; Hospitalization; Hospitals; Imaging Techniques; Information Resources; Interview; Knowledge; Leadership; Linear Models; Measures; Medical; Medical center; Medicare claim; Medicine; Methodology; Myocardial Ischemia; Neighborhoods; Outcome; Outcome Study; Patient Care; Patients; Pattern; Performance; Pharmaceutical Preparations; Plant Roots; Policies; Process; Provider; Qualitative Research; Quality of Care; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Resources; Risk; Series; Source; Standardization; Statistical Data Interpretation; Structure; Surveys; Survival Rate; Technology; Telephone; United States Centers for Medicare and Medicaid Services; Veterans; Veterans Health Administration; base; cardiovascular imaging; care costs; care outcomes; comparative; cost; cost outcomes; data warehouse; design; economic evaluation; experience; implantable device; improved; improved outcome; mortality; multidisciplinary; new technology; operation; patient population; pressure; prevent; programs; provider networks; theories

 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.

 描述（由申请人提供）： 心血管疾病是参加退伍军人健康的退伍军人死亡的主要原因 管理（VHA），也是VHA运营成本的主要组成部分。近年来，VHA 采取了许多护理质量举措来改善心脏病患者的健康结果。同时，VA 临床业务的财政压力有所增加，VHA 越来越被迫优化其医疗保健的价值（即在节省有限资源的同时改善结果）。虽然 VHA 不断收集和报告大量护理过程质量指标来评估 VA 医疗中心 (VAMC) 的临床表现，但人们对 VAMC 层面的心血管结果和护理成本知之甚少。由于缺乏信息，VHA 领导层无法清楚了解 VAMC 在提供高质量心血管护理以实现价值最大化方面的比较表现。我们的多学科团队由心血管结果和经济学方面经验丰富的研究人员组成，建议比较 2010 至 2014 财年 VA 150 个 VAMC 中两种广泛流行且高成本的心血管疾病——缺血性心脏病 (IHD) 和慢性心力衰竭 (CHF) 的结果和护理成本。该研究项目的具体目标是：(1) 确定 VAMC 在这五年期间持续为患有 IHD 和 CHF 的退伍军人带来出色的风险调整健康结果，并量化与产生这些结果相关的护理成本； (2) 确定和量化这些 VAMC 中最有利于获得最佳结果和经济效率的 CHF/IHD 护理的结构方面，特别关注几个高成本护理部分的当地频率的影响，包括：心血管成像、植入式设备的使用、异地主要心血管护理和非选择性住院治疗； (3) 通过采访该国表现最好和表现较差的 VAMC 的领导层和临床提供者，深入探讨关键的临床、计划和领导力以及产生这些结果的因素。为了实现这些研究目标，我们将整合来自 VA 国家患者护理数据库、VA 决策支持系统国家数据提取数据库和 VA 收费基础护理数据库的数据，所有数据均存储在 VA 的企业数据仓库中。其他数据将从美国医院协会的年度医院调查以及退伍军人管理局/医疗保险和医疗补助服务中心的数据中获得，这些数据可从退伍军人管理局信息资源中心获得。将使用分层广义线性模型进行多变量统计分析，以调查医院层面的结果和心血管护理成本，同时控制 VAMC 在 CHF 和 IHD 患者群体中的关键差异。在进行定量分析之后，我们将对前 5 家 VAMC 的行政和临床领导以及一线临床医生进行的一系列电话访谈中收集的信息进行定性评估。 心血管护理价值排名垫底的 5 个 VAMC。这种“扎根理论”定性分析将确定关键的机构、计划和领导因素，这些因素是美国在高价值 IHD 和 CHF 护理方面表现最好的 VA 医疗中心 (VAMC) 的特征，为寻求改善整个 VA 医疗系统心血管护理的 VA 临床和运营领导者提供了重要的蓝图。随后，我们的结果将通过 VA 慢性心力衰竭和缺血性心脏病质量增强研究计划 (QUERIs) 维护的提供商网络传达给 VA 心脏病学的关键政策和临床领导者，该计划的领导者将与该项目的研究团队合作，作为共同研究者，设计和进行研究，以及传播研究结果。