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Managing Variation

The Veterans Health Administration is the largest integrated health care system in the United States, providing care at 152 medical centers and 951 outpatient clinics to over 5.7 million veterans. The document discusses several ways the VHA manages variation in care delivery and outcomes across its facilities. This includes standardizing clinical practices, improving hospital flow, increasing transparency of safety data, implementing a surgical complexity initiative to match procedures with facility capabilities, and using statistical analysis showing a correlation between better quality and efficiency. The goal is to provide high quality and efficient healthcare through continuous performance improvement across the entire system.

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46 views13 pages

Managing Variation

The Veterans Health Administration is the largest integrated health care system in the United States, providing care at 152 medical centers and 951 outpatient clinics to over 5.7 million veterans. The document discusses several ways the VHA manages variation in care delivery and outcomes across its facilities. This includes standardizing clinical practices, improving hospital flow, increasing transparency of safety data, implementing a surgical complexity initiative to match procedures with facility capabilities, and using statistical analysis showing a correlation between better quality and efficiency. The goal is to provide high quality and efficient healthcare through continuous performance improvement across the entire system.

Uploaded by

gschiro
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Department of Veterans Affairs

Veterans Health Administration

Managing Variation
Robert L. Jesse, M.D., Ph.D. Principal Deputy Under Secretary for Health

Veterans Health Administration


Largest Integrated Health Care System in the United States:
152 medical centers 951 community-based outpatient clinics

Healthcare provided to 5.7 million Veterans Fully deployed electronic medical record
VistA - Veterans Health Information System and Technology Architecture

Veterans Health Administration


Healthcare is different from Health Care Health Care is what we strive to provide to individual patients Healthcare describes the systems that enable this You cant have health patients without a healthy healthcare system

Managing Variation
Standardize clinical practices
An SOP for central line insertion decreases infections Using evidence-based practices reduces ICU mortality

Managing flow reduces length of stay Transparency to inspire - ASPIRE Facility privileging - Operative Complexity A system-wide view of efficiency and quality - SFA

Results: Implementation of Evidenced-Based Practices to Reduce Central Line-Associated Bloodstream Infections (183 ICUs)

Reduction in central line infections


Mixed ICU Surgical ICU Coronary Care (CCU) Medical ICU / CCU Medical ICU

10

CLAB Infections/ 1000 line days

9 8 7 6 5 4 3 2 100 1 0

Increased utilization of evidenced based practices


Cap Worn Full body drape Mask Worn Chlorhexidine skin prep Hand hygeine Sterile Gown

Adherence to EBP (%)

95 90 85 80 75

Data: VA Inpatient Evaluation Center Not for distribution

Results: Reduction of VentilatorAssociated Pneumonia


Reduced Ventilator-associated pneumonia rates
12

VAP infections/1000 vent days

10 8
Mixed ICU

6 4 2 0

Coronary Care (CCU) Medical ICU Surgical ICU Medical ICU / CCU

Increased adherence to best practices


Adherence to EBP to reduce VAP
120 100 80 60 40 20 0

Daily readiness to wean Daily Sedation vacation Daily Spon breathing tri DVT prophylaxis HOB elevated 30 deg SUD prophylaxis

Data: VA Inpatient Evaluation Center Not for distribution

Reducing Length of Stay


The Hospital Flow Collaborative (FIX)
Reduction in risk adjusted length of stay in the ICU, 103,000 patients annually * cost of ICU day $3500* 0.3 days = $108 million in cost avoidance

Reduction in risk adjusted length of stay in patients admitted to acute care. 500,000 patient annually *$1500/ day *.5 days = $ 375 million in cost avoidance

VA ICU Outcomes Over Time

Transparency
ASPIRE: Safety Data by VISN

VAs Aspirational goal VAs current performance Safety Metrics

Surgical Complexity Initiative


Procedure Infrastructure Matrix: Operative Complexity Matrix:
Designate inpatient surgical programs as standard, intermediate, or complex based on program capabilities Designate surgical procedures as standard, intermediate, or complex

Match facility infrastructure to the procedures performed


Standard VHA Surgical Programs are limited to scheduling standard surgical procedures (14 programs) Intermediate VHA Surgical Programs may perform standard and intermediate surgical procedures (33 programs) Complex VHA Surgical Programs perform standard, intermediate and complex surgical procedures (66 programs)

Surgical Complexity
Surgical Strategic Plan
Each facility and VISN has a consolidated plan for the care and treatment of Veterans who present at any VHA Surgical Program regardless of complexity designation.

The National Surgery Office is responsible for:


Monitoring each VHA Surgical Program for compliance with facility surgical complexity designation. Annual review of the Procedure Infrastructure Matrix and the Operative Complexity Matrix, with authority to modify as deemed appropriate.

Relationship of Efficiency to Quality


SFA Stochastic Frontier Analysis
Correlation between Clinical Efficiency and Quality (HEDIS & ORYX) by Facility (FY09)
1.3

SFA Clinical Efficiency Score

Correlation = -0.168 P = 0.0494

1.2

1.1

1 0.83 0.85 0.87 0.89 0.91 0.93 0.95

Quality (HEDIS & ORYX)

Better Quality is associated with better efficiency

Veterans Health Administration

[email protected]

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