Higher Preventive Health Inventory Use Associated with Improved Quality of Care
The COVID-19 pandemic caused significant disruptions in primary care delivery. To help primary care deliver chronic and preventive care that was delayed by the pandemic, VA's Office of Primary Care launched the Preventive Health Inventory (PHI) program, a multi-component care management intervention that includes a clinical dashboard of key primary care quality measures to prioritize and a templated electronic health record note that comprises a checklist of items to review with Veterans. This retrospective quality improvement study examined associations between PHI adoption and clinical quality measures at 216 VA primary care clinics nationwide that implemented the PHI and had the highest and lowest PHI use as of February 2021. Using VA data for 829,527 Veterans from February 2021 through February 2022, researchers estimated changes in diabetes and hypertension quality measures associated with PHI implementation, stratifying by low vs. high PHI use at the facility level to measure whether differences in uptake were associated with quality.
- Higher uptake of the PHI was associated with improved quality of diabetes and hypertension care.
- Compared to the lowest use clinics, the highest use clinics had fewer Veterans with an HbA1c >9 or missing (6,578/100,000 vs. 9,928/100,000), more Veterans with an annual HbA1c measurement (13,181/100,000; 8,307/100,000), and more Veterans with adequate blood pressure control (20,582/100,000; 8,306/100,000).
- The highest use clinics completed an average of 32,997 notes per 100,000 Veterans compared to 57 notes per 100,000 Veterans at the lowest use clinics.
- Compared to the lowest use clinics, highest use clinics were larger (12,072 patients vs. 5,713), more likely to be urban, and more racially and ethnically diverse.
- Results indicate that a proactive care management intervention can significantly improve the quality of care, including chronic disease care that has been disrupted by the COVID-19 pandemic.
- Future work should focus on the barriers that some VA clinics face in implementing the PHI, such as rural clinics that may need additional support.
- Because this was an observational study, it can show only associations, not causation.
- Findings might be biased or confounded by other VA systemwide changes that were concurrent with PHI implementation.
- The study assessed VA electronic use of note templates, not direct patient care activities.
This study was supported by HSR&D’s Quality Enhancement Research Initiative (RIVET-QUERI) and VA’s Office of Primary Care. Drs. Wheat, Nelson, and Reddy, and Mr. Gunnink and Rojas are part of the Primary Care Analytics Team (PCAT) and HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care.
Wheat C, Gunnink E, Rojas J, Shah A, Nelson K, Wong E, Gray K, Stockdale S, Rosland A, Chang E, and Reddy A. Changes in Primary Care Quality Associated with Implementation of the Veterans Health Administration Preventive Health Inventory. JAMA Network Open. April 17, 2023; 6(4):e238525.