Assessing Quality of VA and Community Care in the MISSION Era

评估 MISSION 时代 VA 和社区护理的质量

• 批准号: 10533410
• 负责人: TIMOTHY P. HOFER
• 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: 2023-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10533410
• 关键词: Accountability; Affect; Benefits and Risks; Caring; Collaborations; Communities; Community Healthcare; Complex; Contracts; Data; Data Analyses; Decision Making; Development; Diagnosis; Dimensions; Evaluation; Foundations; Geography; Goals; Grant; Health system; Hospital Referrals; Immunotherapy; Implementation readiness; Improve Access; Incentives; Individual; Institution; Learning; Malignant Neoplasms; Malignant neoplasm of prostate; Measurement; Measures; Medical Care Costs; Medical Records; Medicare; Medicare claim; Methodology; Modeling; Monitor; Movement; Patients; Performance; Policies; Policy Maker; Process; Provider; Quality of Care; Race; Recommendation; Registries; Reporting; Research; Research Personnel; Research Priority; Risk; Role; Services; Specific qualifier value; System; Systems Integration; Testing; Time; United States Department of Veterans Affairs; Variant; Veterans; Visit; Work; cancer care; cancer risk; care fragmentation; care systems; data registry; design; flexibility; future implementation; high risk; implementation process; improved; innovation; integrated care; medical specialties; new therapeutic target; treatment planning

Background: With the goal of improving Veteran access to timely services, the MISSION Act is shifting the VA from a tightly integrated system to one that is more “dis-integrated,” with a substantial number of specialty visits now provided by community providers. The use of VA-purchased community care (VA-CC) could improve access for Veterans, but could also increase fragmentation of care, potentially resulting in delays, redundancies, and less coordinated treatment plans. While multiple previous studies have shown a quality advantage for VA relative to community care (CC), we have little understanding of how fragmentation will impact timeliness and quality of care, especially for high-risk conditions such as cancer care. Significance: Fragmented care is a common, serious, and urgent problem for individuals with cancer. This study, which is responsive to several HSR&D research priorities, will examine the quality of cancer care after the institution of CHOICE and MISSION, whether the efforts to coordinate VA-CC are successful in maintaining measured quality, and the degree of risk to quality for patients who divide their care between systems. Results can be used by our VA partners and Veterans to understand variation and deficits in quality. Innovation & Impact: This project focuses on systems of care and the potential risks and benefits to quality when policy incentivizes movement across systems, and develops measures that can be used for monitoring and targeting efforts to change practice and improve cancer care quality received by Veterans in all settings. Key products: 1) a report of cancer care quality across VA-delivered and VA-purchased CC; 2) an assessment of quality for providers in the community who contract with VA relative to geographically proximate providers who do not; 3) a set of cancer quality measures ready for implementation and new measures identified as appropriate targets for future implementation; 4) a set of measures requiring further testing and development; and 5) approaches to enhance implementation in VA and non-VA settings. Specific Aims: 1. Adapt and extend a set of claims and registry-based measures designed to assess cancer care quality in national US health systems for use within VA; 2. Compare the quality of cancer care for Veterans who receive their cancer care within an integrated system to those receiving more fragmented care across systems, and examine differences in measure performance across key predictor variables; and 3. Conduct a Stakeholder Expert Panel (SEP) to recommend a cancer performance measurement set for tracking quality of cancer care in VA and/or non-VA settings and an agenda for near term implementation. Methodology: We will operationalize previously designed claims-based measures of cancer care in VA data and extend the measure set (with additional prostate cancer measures). We will compare quality measure performance for Veterans over 64: 1) Receiving VA-delivered care only vs. receiving any VA-purchased CC; and those 2) Predominantly reliant on VA care vs. reliant on both VA and Medicare. (Data for these analyses includes: VA CDW, VA PIT/purchased care, and VA-CMS.) We will also examine, using CMS data, if quality measure performance is similar for all patients over 64 attending practices under contract with VA to provide community cancer care to patients attending non-contracted practices within the same hospital referral region. Finally, we will examine differences in measure performance across key patient and system predictor variables. Through a Stakeholder Expert Panel, we will prioritize measures, assess gaps in the current measure set and potential measures to fill those gaps, and recommend approaches for implementation. Next Steps/Implementation: Through the work of the Advisory Council and Stakeholder Expert Panel, which involve both VA and non-VA experts, we will create a multi-step process for dissemination of the research products. By engaging policy makers in the process of decision making, the results will be more implementable and sustainable.

背景：为了改善退伍军人获得及时服务的机会，使命法正在转变 退伍军人管理局从一个紧密集成的系统转变为一个更“非集成”的系统，拥有大量的专业 现在由社区提供者提供访问。使用退伍军人管理局购买的社区护理(VA-CC)可以 改善退伍军人的可获得性，但也可能增加护理的碎片化，可能导致延误， 裁员，以及不太协调的治疗计划。虽然之前的多项研究表明， 退伍军人事务部相对于社区护理(CC)的优势，我们对碎片化将如何 影响护理的及时性和质量，特别是癌症护理等高危情况。 意义：对于癌症患者来说，零散的护理是一个常见、严重和紧迫的问题。这 这项研究对几个HSR&D研究优先事项做出了回应，将检查癌症护理的质量 机构的选择和使命，协调退伍军人事务部-CC的努力是否成功 维护可测量的质量，以及将护理分为两部分的患者质量风险程度 系统。我们的退伍军人管理局合作伙伴和退伍军人可以使用结果来了解质量方面的差异和缺陷。 创新与影响：本项目重点关注护理系统及其对质量的潜在风险和好处 当政策激励跨系统移动，并制定可用于监控的措施时 并有针对性地努力改变做法，提高退伍军人在所有环境中接受的癌症护理质量。 主要产品：1)VA提供的和VA购买的CC的癌症护理质量报告；2)评估 社区中与退伍军人管理局签订合同的提供商相对于地理位置较近的提供商的质量 3)一套可供实施的癌症质量措施，以及确定的新措施 未来实施的适当目标；4)需要进一步测试和发展的一套措施； 以及5)加强在退伍军人管理局和非退伍军人管理局环境中实施的办法。 具体目标：1.调整和推广一套旨在评估癌症的声称和登记措施 在退伍军人中使用的美国国家卫生系统的护理质量；2.比较退伍军人癌症护理的质量 他们在一个综合系统内接受癌症治疗，而那些接受更分散的治疗的人 系统，并检查关键预测变量在衡量绩效方面的差异；以及3.进行 利益相关者专家小组(SEP)推荐一套癌症绩效衡量标准，以跟踪癌症的质量 退伍军人事务部和/或非退伍军人事务部的癌症护理和近期实施议程。 方法：我们将在退伍军人事务部的数据中实施以前设计的基于索赔的癌症护理措施 并扩大措施集(增加前列腺癌措施)。我们将比较质量衡量标准 退伍军人对的表现：1)只接受退伍军人管理局提供的护理与接受退伍军人管理局购买的CC相比；以及 2)主要依赖退伍军人管理局的护理，而不是同时依赖退伍军人管理局和联邦医疗保险。(这些分析的数据 包括：VA CDW、VA PIT/购买的护理和VA-CMS。)我们还将使用CMS数据检查是否有质量 根据与退伍军人管理局的合同，所有参加实践的患者的衡量表现相似，以提供 在同一医院转诊区域内对非签约诊所的患者进行社区癌症护理。 最后，我们将检查关键患者和系统预测变量在测量性能方面的差异。 通过利益攸关方专家小组，我们将确定措施的优先顺序，评估当前措施组中的差距，并 为填补这些差距可能采取的措施，并建议执行办法。 下一步/执行：通过咨询理事会和利益攸关方专家小组的工作， 涉及退伍军人管理局和非退伍军人管理局专家，我们将创建一个多步骤的过程来传播 研究产品。通过让政策制定者参与决策过程，结果将更多 可实施性和可持续性。