VA bares all

Depart­ment to re­lease in­ter­nal qual­ity dash­board, new web­site to pub­lic

Modern Healthcare - - The Week In Healthcare - Joseph Conn

The Vet­er­ans Af­fairs Depart­ment this week planned to launch a pro­gram of clin­i­cal per­for­mance trans­parency, ex­pos­ing its own in­ter­nal clin­i­cal qual­ity dash­board to pub­lic view.

The VA also was ex­pected to un­veil on Nov. 22. a new, more con­sumer-friendly web­site that will en­able pa­tients to track the per­for­mance of all VA hos­pi­tals and their af­fil­i­ated clin­ics.

The pub­lic ex­po­sure of the two Web-based dash­boards, the Link­ing Knowl­edge & Sys­tems, or LinKS, which has been in in­ter­nal use at the VA for about two years, and the re­cently de­vel­oped As­pire sys­tem, are part of a pledge made by VA Sec­re­tary Eric Shin­seki when he took of­fice in 2009 to make the VA “as trans­par­ent as pos- sible,” said Robert Pet­zel, the VA’s un­der­sec­re­tary for health.

Pet­zel heads the Vet­er­ans Health Ad­min­is­tra­tion, the depart­ment’s health­care arm, which op­er­ates 153 VA hos­pi­tals and more than 700 clin­ics.

The goal, Pet­zel said, is to “cre­ate an at­mos­phere of trust” with vet­er­ans, mem­bers of Congress and oth­ers with in­ter­est in VA health­care op­er­a­tions. “Be­ing trans­par­ent about your per­for­mance data is one of the ways you build trust with those var­i­ous groups.”

Both sites were slated to be made avail­able to the gen­eral pub­lic Nov. 22 at www.hos pital­com­pare.va.gov.

LinKS presents out­come mea­sures in near real time for acute care, ICU, out­pa­tient, safety and an­nual mea­sures at na­tional, re­gional and lo­cal hos­pi­tal lev­els for out­comes and process mea­sures. It gives pa­tients and per­son­nel at each of the med­i­cal cen­ters an op­por­tu­nity to look at their own per­for­mance as well as the per­for­mance of ev­ery other med­i­cal cen­ter in the VA sys­tem, Pet­zel said.

As­pire uses color schemes, di­rec­tional ar­rows and drop boxes for de­tailed ex­plana­tory ma­te­ri­als about the mea­sures be­ing col­lected and re­ported. It also breaks down the data for com­par­i­son at the na­tional level, across the VA’s 21 re­gions, and by 137 health­care “sys­tems,” which in VA par­lance are in­di­vid­ual hos­pi­tals or groups of sev­eral hos­pi­tals with a shared lead­er­ship group.

Each sys­tem can be mea­sured against a set of as­pi­ra­tional goals, which in turn are “bench­marked against the ab­so­lute best in the coun­try in the pri­vate sec­tor,” said Wil­liam Dun­can, as­so­ci­ate deputy un­der­sec­re­tary for health qual­ity and safety, who over­sees the As­pire project.

Data from those com­mu­nity-based out­pa­tient clin­ics as­so­ci­ated with a med­i­cal cen­ter are rolled up into that med­i­cal cen­ter in the re­ports.

The As­pire sys­tems uses col­ors to pro­vide vet­er­ans and other non­clin­i­cians an easy-to­com­pre­hend pic­ture of where each hos­pi­tal is in re­la­tion to the best-in-the-nation bench­marks and uses ar­rows to in­di­cate whether each met­ric is trend­ing up or down.

The goals af­ford the pub­lic, clin­i­cians and VA lead­er­ship with “a high-level ex­ec­u­tive look at where we want to be in three to five years,” Dun­can said. “Our sec­re­tary and our un­der­sec­re­tary wanted both of those to be avail­able pub­licly. So, we’re hang­ing it out there.”

“We’ll be track­ing each or­ga­ni­za­tion’s progress to­ward these goals, and when we find peo­ple who are stalled, we’ll ad­dress that,” he said. “The sec­re­tary will be look­ing at this and that tends to get a lot of at­ten­tion.”

Dun­can said As­pire re­mains a work in progress. “One of my goals is to have videos, so when you click on the video, it will ex­plain what the met­rics mean,” Dun­can said. “There will be it­er­a­tions in the fu­ture to make this much, much more user-friendly and un­der­stand­able.”

As­pire groups its out­comes and process mea­sures un­der the six do­mains of the In­sti­tute of Medicine’s Cross­ing the Qual­ity Chasm— pa­tient safety, clin­i­cal ef­fec­tive­ness, ef­fi­ciency, time­li­ness, pa­tient cen­tered­ness and eq­ui­table care.

“We tried to get met­rics for each of those do­mains,” Dun­can said. “We don’t have the data pop­u­lated for each of those met­rics this year. We’re ex­pect­ing in the next quar­ter to have some of that ad­di­tional data an­a­lyzed.”

The VA con­sid­ered as an al­ter­na­tive to build­ing its own site ex­pand­ing its par­tic­i­pa­tion in HHS’ pub­lic re­port­ing ini­tia­tive, Hos­pi­tal Com­pare, Dun­can said. The VA joined Hos­pi­tal Com­pare in March, but the source for it is Medi­care data and “we’ve never billed Medi­care,” Dun­can said.

Plus, Dun­can said, “The data on hos­pi­tal com­pare is any­where from 18 to 24 months old, so there is a sig­nif­i­cant lag, and that was un­ac­cept­able to the sec­re­tary.”

The VA data is re­freshed ev­ery three months, ac­cord­ing to a VA spokesman.

Dun­can: “We’re hang­ing it out there” with goals.

Pet­zel: We’re try­ing to build trust through trans­parency.

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