Background:
The US Department of Veterans Affairs (VA) collects measures of healthcare quality at every VA hospital, producing reports that compare individual VA Medical Centers with all other VA Medical Centers and Medicare data. The goal of the Transparency in Quality of Care initiative is to provide veterans with information about the quality of healthcare in VA Medical Centers. The hypothesis is that as patients learn more about the quality of the care they receive, they will take a more active role in managing their health. The VA Personal Health Record, My HealtheVet, empowers veterans to self-manage their health by providing a way to track personal measures and collaborate with the healthcare team on interventions.
Measures:
Initial measures reported come from Joint Commission and Healthcare Effectiveness Data and Information Set (HEDIS) quality measures. The VA scores are compared against Healthcare Effectiveness Data and Information Set HEDIS (a set of quality measures used across the healthcare industry). Medicare sources provide the Healthcare Effectiveness Data and Information Set HEDIS data used for comparison. These measures focus on conditions that can be prevented or treated to reduce illness. Three measures relate to diabetes care, one measure reflects prevention of flu, and one measure reflects pneumonia care. These five measures look at the percentage of patients in a VA medical center who meet the measurement goals. The five measures and their goals are (1) hemoglobin A1c level of less than 9, (2) low-density lipoprotein cholesterol (LDL-C) level of less than 100, (3) blood pressure less than or equal to 140/90, (4) flu shot vaccination given, and (5) oxygen assessment done within 24 hours of hospital arrival.
Evaluation:
The Quality of Care Web site (http://www.qualityofcare.va.gov/) teaches what the measures mean, how to read the charts provided, and how to use My HealtheVet (http://www.myhealth.va.gov/). Using the Track Health feature, veterans self-enter their hemoglobin A1c, LDL-C, blood pressure, and pulse oximetry measures. Registered authenticated veterans receive healthcare alerts, including seasonal flu vaccination reminders. Using the immunizations feature, veterans self-enter their flu shot. Veterans can share this self-entered information with their healthcare team.
Impact:
The Quality of Care workgroup assesses the impact of providing this information. Reports now cover 42 VA hospitals in five regions. Eventually, reports will be available for 21 geographic regions. The next five measures will be available in 2009.