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Facility-level impact of VA profiling on chronic disease quality and preventive practices
Yano EM, Mittman BS, Rubenstein LV. Facility-level impact of VA profiling on chronic disease quality and preventive practices. Paper presented at: Society of General Internal Medicine Annual Meeting; 2002 May 1; Atlanta, GA.
BACKGROUND While not without controversy, practice and provider profiling of utilization and quality indicators provide enhanced decision support for effective practice management. While some studies point to profiling's potential benefits, little is known about its impact across an entire health care system. We evaluated the relationship between VA adoption of profiling practices and measures of facility performance. METHODS We classified the level of profiling at 235 VA primary care practices nationwide using items previously validated among California managed care organizations. We merged (1) facility-level overall and component scores for the Chronic Disease Index (CDI) and Prevention Index (PI), (2) workload (# outpatients, # visits) (VA Outpatient Clinic file), and (3) managed care penetration (HIAA Sourcebook). Bivariate and multivariate analyses were conducted to assess the extent to which profiling was associated with CDI and PI scores, adjusting for facility characteristics such as urban/rural location and academic affiliation. RESULTS Profiling methods varied (outpatient prescriptions 81% to hospitalization rates 27%). Profiling was less prevalent in urban centers (p < .05), and unrelated to area managed care penetration. VAs with higher-than-average profiling had higher overall CDI scores (p < .01), stemming from better diabetic (foot sensation exams, pedal pulses, lower HbA1Cs) and hypertension care (exercise and nutrition counseling) (all p < .05). Profiling VAs had higher rates of alcohol, tobacco and colorectal cancer screenings; prostate cancer counseling, and flu shots (all p < .05), which contributed to a better overall PI score (p < .01). After multivariate adjustment for medical center features associated with performance, adoption of profiling was independently associated with better CDI scores (p < .05), but not PI scores, where complexity was the singlemost important predictor (p < .0001). CONCLUSION Use of practice- and provider-level profiling is associated with better chronic disease quality, regardless of organizational complexity or academic affiliation. With new initiatives to expand profiling, VA managers need to be educated about their potential chronic care benefits. Further work is needed to ascertain why prevention gains are not realized.