QUERI – Quality Enhancement Research Initiative

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Ischemic Heart Disease (IHD) QUERI
» Seattle, WA

Mission

The overall mission of the Ischemic Heart Disease Quality Enhancement Research Initiative (IHD QUERI) is to improve the quality of care and health outcomes of veterans with IHD by working collaboratively with operational units and other QUERI groups to enable implementation of best practices in acute care, chronic illness care, and secondary prevention. IHD-QUERI has invested substantial effort into forging partnerships with VA leaders to support interventions that both improve care and foster implementation research, including direct collaboration with Patient Care Services, the Office of Quality and Performance, the Office of Information, Employee Education Services, and the National Clinical Practice Guidelines Council.

Background

Ischemic heart disease (IHD) is responsible for more than 1 of every 5 deaths in the United States and remains the single largest killer of males and females in the US. In 2004, the total cost (direct and indirect) for caring for patients with IHD exceeded $133 billion. Over 500,000 VHA patients have a diagnosis of IHD, a leading cause of mortality and hospitalization for veterans. Despite advances in care, significant gaps remain in the implementation of best practices for IHD. Between 10-40% of acute coronary syndrome patients do not receive guideline-indicated therapies at discharge even when they are eligible. In the VA, data supports that just over half of outpatients with IHD are managed in a manner fully consistent with existing guidelines.

Goals

In 2011, the IHD QUERI reframed our focus and scope to think more broadly and approach IHD as a disease continuum rather than focusing on discrete stages of disease. As a result, our center goals are driven less by specific clinical foci within IHD, but rather more by efforts to develop and exploit specific platforms for interventions with our operational partners.

The major goals and objectives of the IHD QUERI include:

Goal #1: Leverage data stored in new and existing information systems to improve the quality and safety of care for IHD patients at point of service

  • Objective 1-1: Improve the availability of timely clinical information at point of decision making
  • Objective 1-2: Track changes in quality of care and outcomes for AMI
  • Objective 1-3: Develop implementation tools and interventions at program level to facilitate care and improve efficiency
  • Objective 1-4: Identify organizational factors associated with the utilization of clinical data

Goal #2: Improve cardiovascular risk factor management by integrating new programs into evolving systems of care
  • Objective 2-1: Identify and understand differences in risk factor management and their causes
  • Objective 2-2: Identify organizational and contextual factors that influence risk-factor management
  • Objective 2-3; Develop implementation tools and interventions at program level to facilitate care and improve efficiency

These revised goals reflect an increasing focus on improving systems of care as opposed to discrete processes of care. Of particular significance for IHD are goals to improve coordination of care among specialists and with primary care, and to proactively manage patient risk factors.

In routine clinical practice, therapies are often provided to patients or in clinical scenarios not tested in research trials, potentially leading to differences in effectiveness and safety. This requires development of methodologies to assess the effectiveness and safety of treatments as they are being used in practice. Our vision is to develop and package risk factor management strategies that can be readily integrated into care systems, notably through IT systems, such as CART, and as part of the new models of care in the national implementation of the patient aligned care team (PACT).

For more details please refer to our Strategic Plan and IHD-QUERI R&M Presentation slides (links at right above).

For more information about IHD-QUERI please contact Gordon (Blake) Wood at Gordon.Wood@va.gov.