QUERI – Quality Enhancement Research Initiative

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Disseminating a Dashboard for VA Purchased Community Nursing Homes

Providence, RI

Overview:

The VA Geriatrics and Extended Care Data and Analysis Center (GEC DAC) has recently assembled a dashboard for Community Nursing Home (CNH) quality, based on nationally published metrics of nursing home performance. The dashboard provides important information for facility GEC leaders and contracting officials, as well as for VISN and national GEC leaders. The CNH Dashboard identifies the quality of CNH facilities, where the VA is purchasing CNH care using the Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare 5-star quality rating system. The CNH Dashboard also identifies the quality of other CNHs within the VA healthcare system. For facility GEC leaders and contracting officials, the CNH Dashboard has a 'drill down' feature which links to the quality of specific CNH facilities, both contracted and non-contracted, within a medical center market. Facility GEC leaders and contracting officials can utilize the dashboard to assess the quality of VA purchased CNH facilities and identify high-quality CNH facilities.

Thus, the overarching goal of this project is to improve the quality of care Veterans receive in purchased CNH facilities. To accomplish this, investigators will examine the process for purchased CNH selection and oversight, introduce the CNH dashboard as a tool to inform decisionmakers about quality of purchased CNH care, and enhance Veteran-specific CNH quality measures on the CNH Dashboard.

Objectives:

The overarching goal is to improve the quality of care Veterans receive in purchased CNH facilities, which includes three overall aims:

1. Understand the role of quality measurement by examining the purchased CNH selection process;

2. Evaluate the impact of the CNH Dashboard implementation on the quality of VA Purchased CNH care relative to other CNH facilities; and

3. Evaluate the quality of Veteran-specific care in purchased CNH facilities by transition and safety outcome measures derived from Veteran-specific CMS data.

Methodology:

Investigators will map the process of CNH selection, contracting, and monitoring by conducting semi-structured interviews with contract officials and GEC leaders. They will evaluate the effect of the CNH Dashboard release in a randomized, stepped-wedge dissemination. This dissemination design allows them to determine the impact of the CNH Dashboard on the quality of purchased CNH facility more systematically than a single phase roll-out. In each of the 4 steps, they will release the CNH Dashboard to a randomly selected set of VISNs. An educational program designed to address the process gaps of CNH selection will accompany the CNH Dashboard release. They will then evaluate the quality of care for Veterans in VA purchased Community Nursing Homes.

Operational Partner: The Office of Geriatrics and Extended Care (GEC) works to "honor veterans' preferences for health, independence, and well-being in the face of aging, disability, or illness by advancing expertise, programs, and partnerships." The GEC also is responsible for the oversight and planning of purchased Community-based Nursing Home care for eligible Veterans at an annual cost of $810 Million.

Principal Investigator: James Rudolph, MD; contact at James.Rudolph@va.gov .