QUERI – Quality Enhancement Research Initiative

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Precision Monitoring to Transform Care (PRISM)

Indianapolis, IN

Principal Investigators: Teresa Damush, PhD (Corresponding PI, VA Indianapolis), Dawn Bravata, MD (VA Indianapolis), Salomeh Keyhani, MD (VA San Francisco), Linda Williams, MD (VA Indianapolis)

Principal Operational Partners: Office of Analytics and Business Intelligence, Inpatient Evaluation Center, Office of Specialty Care Services (SCS), National Center for Health Promotion and Disease Prevention (NCP), VA Telehealth Services, and Veterans Engineering Resource Center (VERC).

Executive Summary

VA is unquestionably a leader in the use of electronic health record (EHR) data to inform clinical, operational, and administrative decisions. Despite growing accessibility, data are most commonly used to retrospectively evaluate quality of care rather than to provide the right data at the right time to the right person in a way that increases patient and staff satisfaction - and improves healthcare.

Program MyVA Goals: This program will establish a culture of continuous performance improvement. The projects lead directly to the implementation and evaluation of tools that will be useful across all VA facilities and multiple clinical settings. The MyVA initiative will reorient VA around Veterans' needs and empower employees to assist them in delivering excellent customer service to improve their experience with VA healthcare.

Program Objectives:

The Precision Monitoring (PRIS-M) to Transform Care programaims to:

  • Implement and evaluate electronic clinical quality measures (eCQMs) and decision support tools at point of care;
  • Conduct scalable clinical quality improvement projects that link electronic data to provider actions and reporting;
  • Investigate the effects of providing actionable EHR-based data on care team and Veteran satisfaction
  • Identify implementation strategies that activate VA providers, leaders, and Veterans to use data to transform care.

Investigators will address important implementation questions about how best to use data to activate providers, healthcare teams, and Veterans to improve healthcare delivery and outcomes.

Program Methods:

With ongoing input of core partners, program goals will be accomplished via core research and quality improvement projects that cover multiple conditions and care settings. Projects focus on:

  • National implementation of inpatient eCQMs,
  • Testing telehealth modules and eCQMs for improving rapid transient ischemic attack care,
  • Decision support to de-implement inappropriate carotid ultrasound image ordering, and
  • Local quality improvement project to implement and evaluate a remote sleep apnea monitoring program.

In addition, the PRIS-M program includes two additional projects: one to implement and evaluate the first Emergency Department Clinical Pathway decision support tool (acute stroke care) being rolled out to facilities in January 2016, and one to implement a local program of electronic documentation and display of patient behavior change goals to improve coordination and satisfaction with care. These projects are supported by an Implementation and Data Core that works across all projects to facilitate efficient use of data, usability testing of new tools, and standardized use of implementation measures, methods, and analytic approaches. The overarching implementation strategy focuses on activating individuals and groups to use data to transform care. The Consolidated Framework for Implementation Research (CFIR) framework will be used to plan data collection and analyses across projects to identify core implementation strategies and contextual factors that impact how people use data to transform healthcare.

Project Summaries:

Project 1 (Quality Improvement):Compare the use of a generated electronic quality measure (eCQM) toolkit versus external facilitation, ideally in 10 of the lowest stroke-performing VA hospitals in order to determine how to best improve patient experiences before they are discharged from hospital care.

Project 2:Implement an intervention to better treat Veterans who have just had a transient ischemic attack (TIA) or a minor stroke to prevent more threatening consequences through a TIA/minor stroke program conducted by nurses over the telephone.
Project 3:Reduce the number of carotid ultrasounds ordered for Veterans with asymptomatic carotid stenosis, using a CPRS-based decision support tool in three test sites. Additionally, investigators will evaluate the effectiveness of the implemented tool in order to expand the tool to other facilities, if it proves to be successful.