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最前沿。这项工作的大部分是 侧重于评估风险调整后的术后并发症，对重要护理的关注较少 过程，甚至更少关注评估和提高整个手术过程的质量。 护理，包括术前。调整现有措施和新措施， 准确评估手术护理的完整连续性将随着更多退伍军人使用VA而增加- 社区护理（CC）虽然三分之一的VA患者接受CC，但质量评估远未达到 CC比VA内接受治疗的患者发育更差。 意义：质量评估的重点是术后结局和并发症， 在整个外科连续体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， 在手术前的阶段使用不足确定的护理阶段，构成了一套服务， 治疗临床疾病，已被推广到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尚未使用事件模型来监测质量，但VA具有 有机会使用手术事件框架更广泛地衡量手术质量，了解 这种方法的价值，并告知未来VA交付和VA购买的CC的质量报告需求。的 考虑到VA的快速增加，检查手术事件质量的重要性更加突出， 购买CC，不可避免地需要确保在所有设置中保持质量。 创新和影响：本提案的目标是开发一个创新模型来衡量条件- 3种常见的特定手术事件质量，包括术前、术中和术后护理阶段 不同复杂程度的程序。这项工作将推进质量测量科学， 在整个手术过程中进行评估。在将此模型应用于现有的VA和CC数据时，我们将 确定VA医疗中心手术质量改进的新机会，并将促进条件- VA和CC设置之间的发作质量差异的具体比较。我们还将确定限制 在使用现有CC数据源的CC相对于VA的发作质量评估中。 具体目标：目标1：定义手术事件质量评价的特定条件质量指标。目的 2：测量VA医疗中心之间基于事件的质量测量的性能差距和可靠性。 目的3：评估在CC环境中应用基于情节的质量测量的可行性。 方法：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。一个德尔菲小组将对新提出的质量指标的表面有效性、重要性和可行性进行评级 用于包含在手术事件质量测量模型中。目标2：我们将应用剧集质量 测量模型（在目标1中定义）与VA国家数据相比较，以评估设施级别的事件质量变化 并测量模型的可靠性，以描述VA设施的性能。目标3：采用质量措施 适用于VA和CC管理数据源，我们将比较VA和CC中的事件质量 在类似的医疗保健市场中的设置，识别应用事件质量测量的限制 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合作， 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 用于改进CC的剧集质量测量。合作伙伴也可以利用这项工作， 退伍军人的选择，并将协助退伍军人管理局领导人通知“制造与购买”的政策决定。