Disseminating a Dashboard for VA Purchased Community Nursing Homes

 描述（由申请人提供）： 背景资料：VA老年病和扩展护理办公室（GEC）负责监督和规划为符合条件的退伍军人购买的社区护理之家（CNH）护理，每年费用为8.1亿美元。CNH设施的选择、承包和质量监督由当地的VAMC执行。VAMC或VISN的CNH质量标记不容易提供给GEC领导层。GEC数据和分析中心（GEC DAC）开发了一个用于购买CNH质量的仪表板。CNH仪表板比较了医疗保险和医疗补助服务中心（CMS）对CNH设施的5-星星评级的比率，其中VAMC购买护理（观察到的）与周围社区的非签约CNH设施（预期的）。对观察到的预期比率（O/E）指标的初步分析表明，VA购买的CNH护理在CMS的5-星星评级中的表现通常低于非合同CNH设施（平均O/E 0.86 ±0.17），并且在VAMC设施之间存在很大的差异（O/E范围为0.32至1.31）。O/E总结了所有CNH居民的CMS 5-星星排名，而不仅仅是退伍军人。从退伍军人事务部的角度来看，CNH质量的最终衡量标准是确定退伍军人特定水平的护理质量。因此，有重大的机会，了解和提高质量的CNH过程。目标：本提案的总体目标是提高退伍军人在购买的CNH设施中获得的护理质量。为实现这一目标，本提案有三个目标：目标1）通过检查CNH采购选择过程了解质量测量的作用，目标2）评估CNH仪表板实施对VA购买CNH护理质量的影响（相对于其他CNH设施），和目标3）通过从退伍军人特定CMS数据中获得的过渡和安全结果指标，评估购买的CNH设施中退伍军人特定护理的质量。研究方法：我们将通过与合同官员和GEC领导人进行半结构化访谈，绘制CNH选择、合同签订和监控的流程图。我们将评估CNH仪表板发布在随机、阶梯楔形传播中的效果。这种传播设计使我们能够比单阶段推出更系统地确定CNH仪表板对所购CNH设施质量的影响。在这4个步骤中，我们将向随机选择的一组VISN发布CNH仪表板。CNH仪表板的发布将附带一个旨在解决CNH选择过程差距的教育计划。最后，我们将通过获取CNH中退伍军人的详细质量和结果CMS数据来评估VA购买CNH中退伍军人的护理质量。调查结果：目前，退伍军人事务部正在购买的CNH护理在CMS 5-星星排名系统中的质量低于VAMC市场上的其他CNH设施。CNH仪表板为地方、地区和国家层面的GEC领导者提供可操作的信息，这些信息将提高CNH护理的质量。状态：这个为期两年的计划是由博士詹姆斯鲁道夫，弗吉尼亚州波士顿老年病学家，谁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，实施工作得到了由Orna Intrator博士领导的GEC DAC的大力支持。GEC DAC指导委员会将监督该计划的进展。影响：完成后，该计划将提高退伍军人在VA购买的CNH计划中获得的护理质量，如CNH设施和退伍军人特定措施的改进选择所证明的那样。

 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.