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Translating the AHRQ Quality Indicators to the VA
Borzecki AM, Loya PM, Chew PW, Loveland S, Rosen AK. Translating the AHRQ Quality Indicators to the VA. Poster session presented at: VA QUERI National Meeting; 2008 Dec 10; Phoenix, AZ.
The AHRQ Quality Indicators (QIs) are evidence-based measures that screen for potential inpatient and outpatient quality problems using administrative data. Despite extensive non-VA use, QIs have received little VA attention. Application of these measures to VA data presents a unique opportunity to advance VA's quality improvement agenda. Our study goal is to identify a set of reliable, valid, high-priority QIs that complement existing VA quality measures.
To bridge the gap between research and policy and facilitate eventual adoption of measures based on study findings, we developed a strong collaboration with VA stakeholders. We convened a panel with representation including OQP, PCS, NCPS, NSQIP, NEPEC, VANOD, and QUERI, tasked with determining which QIs were of highest VA priority and warranted further study. Using a consensus panel model based on the RAND Appropriateness Method, we held monthly teleconferences with two voting rounds per indicator set during the study's first 6 months. Members rated measures on appropriateness for further study based on VA importance and overlap with existing measures. We also solicited more open-ended input on appropriateness for study in special populations. Based on these selections we are conducting analyses on national VA data. Findings will be reported to the stakeholders and further consensus solicited. This will be an ongoing iterative process. As results become available, we will report to and have stakeholders re-rate measures as appropriate for retention as VA quality measures.
We are currently performing analyses on the Inpatient QIs (IQIs) and Prevention QIs (PQIs). IQIs screen for inpatient quality problems including in-hospital procedure and condition-specific mortality. PQIs measure hospitalization rates for conditions wherein admissions are potentially avoidable through good outpatient care. From the preliminary consensus, 22/23 IQIs and 11/13 PQIs were kept; selected indicators are also being analyzed in diabetes, spinal cord injured, seriously mentally ill, HIV, stroke, and nursing home patients.
Directly involving VA leaders in our project will enable identification of a set of reliable/valid quality measures, relevant and specific to VA's needs and priorities, thus facilitating VA adoption.
The QIs will complement existing quality measurement systems and provide a more comprehensive view of quality throughout the VA.