Assessing Episode-Based Surgical Quality in VA and Community Care Settings

评估 VA 和社区护理机构中基于事件的手术质量

• 批准号: 10532533
• 负责人: Erika D Sears
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10532533
• 关键词: Attention; Authorization documentation; Caring; Clinical; Communities; Community Healthcare; Continuity of Patient Care; Data; Data Sources; Evaluation; Face; Future; Goals; Healthcare; Healthcare Market; Hospitals; Inguinal Hernia; Measurement; Measures; Medical; Medical center; Methodology; Methods; Modeling; Monitor; Operative Surgical Procedures; Outcome; Participant; Patient Care; Patients; Performance; Perioperative; Phase; Policies; Postoperative Care; Postoperative Complications; Postoperative Period; Procedures; Process; Provider; Quality of Care; Recommendation; Reporting; Research; Risk Adjustment; Risk Assessment; Scanning; Science; Services; Standardization; Time; Tracer; Variant; Veterans; Work; authority; care delivery; care episode; care systems; cost; experience; improved; innovation; knee replacement arthroplasty; programs; repaired; response

Background: Since initiation of the National Surgical Quality Improvement Program nearly 30 years ago, VA has been at the forefront of surgical quality measurement and improvement. Much of this work has been focused on assessing risk-adjusted postoperative complications, with less attention paid to important care processes, and even less attention to evaluating and improving quality across the full continuum of surgical care, including the presurgical period. The importance of adapting current and new measures to reliably and accurately assess the full continuum of surgical care will increase as greater numbers of Veterans use VA- purchased Community Care (CC). While one out of three VA patients receive CC, quality assessment is far less developed for CC than for those receiving care within the VA. Significance: With the focus of quality assessment being on postoperative outcomes and complications, quality of care across the entire surgical continuum is largely ignored, especially issues of timeliness, overuse, and underuse in the presurgical period. Defined episodes of care, which constitute a set of services provided to treat a clinical condition, have been promoted to assess quality, coordination, and cost among providers involved in a patient’s care. Although episode models have not been used by VA to monitor quality, VA has the opportunity to use a surgical episode framework to measure surgical quality more broadly, understand the value of this approach, and inform future quality reporting needs for VA-delivered and VA-purchased CC. The importance of examining surgical episode quality is even more salient given the rapid increase in VA- purchased CC, with an inevitable need to ensure that quality is maintained across all settings. Innovation and Impact: The goal of this proposal is to develop an innovative model to measure condition- specific surgical episode quality, including pre-, peri-, and postoperative care phases, for 3 common procedures of varying complexity. This work will advance the science of quality measurement through assessment across the entire surgical continuum. In applying this model to existing VA and CC data, we will identify new opportunities for surgical quality improvement in VA medical centers and will facilitate a condition- specific comparison of episode quality differences between VA and CC settings. We will also identify limitations in episode quality assessment for CC relative to VA using existing CC data sources. Specific Aims: Aim 1: Define condition-specific quality measures for surgical episode quality evaluation. Aim 2: Measure the performance gap and reliability of episode-based quality measures across VA medical centers. Aim 3: Assess the feasibility of applying episode-based quality measurement in the CC setting. Methodology: Aim 1: We will identify new quality measures in response to identified episode measurement gaps. A Delphi panel will rate the newly proposed quality measures for face validity, importance, and feasibility for inclusion in the surgical episode quality measurement model. Aim 2: We will apply the episode quality measurement model (defined in Aim 1) to VA national data to assess facility-level variation in episode quality and measure the reliability of the model to profile VA facility performance. Aim 3: Using quality measures applicable to both VA and CC administrative data sources, we will compare episode quality in VA and CC settings within similar healthcare markets, identifying limitations in applying the episode quality measurement model to existing CC data for meaningful VA and CC quality comparisons. Next Steps/Implementation: We will use the findings of this research to work with partners to refine and expand the measurement model to other surgical conditions to improve care quality for Veterans more broadly, identify targets for cooperative quality improvement within VA and CC settings, and provide recommendations for improvement of episode quality measurement for CC. This work can also be used by partners to inform Veteran choices and will assist VA leaders to inform “make versus buy” policy decisions.

背景：自近 30 年前启动国家外科质量改进计划以来，VA 一直处于手术质量测量和改进的前沿。这项工作的大部分内容已经 侧重于评估风险调整后的术后并发症，较少关注重要护理 过程，甚至更少关注评估和提高整个手术连续过程的质量 护理，包括术前阶段。采用当前和新措施以可靠和可靠地实施的重要性 随着越来越多的退伍军人使用 VA-，准确评估手术护理的完整连续性将会增加 购买了社区护理 (CC)。虽然三分之一的 VA 患者接受 CC，但质量评估还很遥远 CC 的发展程度低于在 VA 内接受护理的人。 意义：由于质量评估的重点是术后结果和并发症， 整个手术过程中的护理质量在很大程度上被忽视，特别是及时性、过度使用、 并且在术前阶段使用不足。定义的护理事件，构成了提供给以下对象的一系列服务： 治疗临床病症，已被提升为评估提供者之间的质量、协调和成本 参与病人的护理。尽管 VA 尚未使用情节模型来监控质量，但 VA 有 有机会使用手术事件框架来更广泛地衡量手术质量，了解 这种方法的价值，并告知 VA 交付和 VA 购买的 CC 未来的质量报告需求。这 鉴于 VA- 的快速增加，检查手术事件质量的重要性更加突出 购买了 CC，不可避免地需要确保在所有设置下都能保持质量。 创新和影响：该提案的目标是开发一种创新模型来衡量条件- 针对 3 种常见情况的特定手术事件质量，包括术前、围术期和术后护理阶段 不同复杂程度的程序。这项工作将通过以下方式推进质量测量科学： 整个手术连续过程的评估。将此模型应用于现有的 VA 和 CC 数据时，我们将 确定提高 VA 医疗中心手术质量的新机会，并将促进条件- VA 和 CC 设置之间的剧集质量差异的具体比较。我们还将确定限制 使用现有的 CC 数据源对 CC 相对于 VA 的剧集质量进行评估。 具体目标： 目标 1：定义手术事件质量评估的具体情况质量测量。目的 2：衡量 VA 医疗中心基于事件的质量措施的绩效差距和可靠性。 目标 3：评估在 CC 设置中应用基于片段的质量测量的可行性。 方法论：目标 1：我们将根据已确定的事件测量确定新的质量测量 差距。德尔福小组将对新提出的质量措施的表面有效性、重要性和可行性进行评级 纳入手术事件质量测量模型。目标 2：我们将应用剧集质量 测量模型（目标 1 中定义）到 VA 国家数据，以评估设施层面的事件质量变化 并衡量模型的可靠性以分析 VA 设施性能。目标 3：使用质量措施 适用于 VA 和 CC 行政数据源，我们将比较 VA 和 CC 中的剧集质量 类似医疗保健市场中的设置，确定应用事件质量测量的局限性 模型与现有 CC 数据进行有意义的 VA 和 CC 质量比较。 后续步骤/实施：我们将利用这项研究的结果与合作伙伴一起完善和实施 将测量模型扩展到其他手术条件，以更广泛地提高退伍军人的护理质量， 确定 VA 和 CC 环境中合作质量改进的目标，并提供建议 改进 CC 的剧集质量测量。这项工作也可以被合作伙伴用来告知 退伍军人的选择将协助退伍军人管理局领导人告知“自制还是购买”的政策决策。