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Harnessing VA Data to Improve the Delivery and Efficiency of VA Healthcare

Several recent initiatives – both outside and within VHA – are making strides toward evidence-based policymaking, a priority for the Obama administration. Most recently, the Evidence-Based Policymaking Commission Act, enacted on March 30, will establish a commission to study and recommend changes to federal data and statistical infrastructure in support of outcomes measurement and facilitation of randomized program evaluation. VA has already taken the lead in this direction by establishing the HSR&D/QUERI-funded Partnered Evidence-Based Policy Resource Center (PEPReC), which was launched last Fall (co-PIs, Julia Prentice, PhD, and Austin Frakt, PhD). PEPReC is designed to harness VA quantitative and qualitative data for program evaluation to improve the delivery and efficiency of VA healthcare. Its findings will support the development of high-priority policy, planning, and management initiatives.

The need for PEPReC and evidence-based policy became acutely evident with the passage of the Veterans Access, Choice, and Accountability Act of 2014 (Choice Act). VA policymakers and managers were tasked with improving access to and quality of VA healthcare while simultaneously financing Veterans' choices of non-VHA care at a time when demands on the VA budget were growing rapidly. Consequently, policymakers and managers have several urgent tasks before them that could benefit from better evidence: accurately forecasting the demand for VA care; efficiently deploying resources where they are most needed; monitoringperformance, including access to care; and making sound decisions about major new investments.

PEPReC's core mission includes refining VA measurements of access to care, productivity, demand, and capacity, as well as investigating relationships among them to improve policy and planning. Recently, HSR&D selected research partners in support of four randomized program evaluations, to be conducted in collaboration with PEPReC:

• "Veteran-Directed Home & Community Based Services," with the Office of Geriatrics and Extended Care (GEC). Partner co-PIs: James Rudolph, MD, and Kali Thomas, PhD, HSR&D Center of Innovations in Long-Term Services and Supports for Vulnerable Veterans, Providence, RI.
• "Predictive Model-Based Targeted Risk Mitigation for Patients Receiving VA Opioid Prescriptions Who are at High Risk of Adverse Events," with the Office of Mental Health Operations. Partner co-PIs: Walid Gellad, MD, and Leslie Hausmann, PhD, HSR&D Center for Health Equity Research and Promotion (CHERP), Pittsburgh and Philadelphia, PA.
• "Risk Stratified Enhancements to Clinical Care: Targeting Care for Patients Identified through Predictive Modeling as Being at High Risk for Suicide," with the Office of Mental Health Operations. Partner PI: Sara Landes, PhD, HSR&D Center for Mental Healthcare and Outcomes Research (CeMHOR), North Little Rock, AR.
• "Impact of Mobile Teledermatology on Skin Care Delivery and Patient Outcomes," with the Office of Connected Care. Partner co-PIs: Dennis Oh, MD, San Francisco VA Health Care System, and Martin Weinstock, MD, PhD, Providence VA Medical Center.

In addition to collaborating on these randomized evaluations, PEPReC also helps monitor and evaluate impacts of major investments, such as new versions of VistA (Veterans Health Information Systems and Technology Architecture), and refine VA's budget projections. In consultation with VA's Office of Policy and Planning, PEPReC uses statistical and econometric models to forecast supply and demand responses to policy initiatives and changes in healthcare and labor market conditions.

In response to requests, PEPReC assists operations partners with program evaluation design, data capture, verification, and analysis. PEPReC also analyzes large administrative databases primarily from VA, Medicare, and Medicaid. Potential studies are prioritized by their anticipated impact on VA policy and healthcare system needs, as well as the availability of resources from the operations partner to support the proposed study. In addition to the Director of HSR&D, the PEPReC Advisory Committee includes representatives from VA's Office of Policy and Planning, VA Clinical Operations, Office of Mental Health Operations, and the Office of Informatics and Analytics.

The Evidence-Based Policymaking Commission Act sends the correct signal that necessary conditions for sound policymaking include relevant data, reliable infrastructure to support its use, and strong research designs. With PEPReC, VA is well positioned to apply these tools to meeting the challenges laid out in the Choice Act.

Austin Frakt, PhD, Steven Pizer, PhD, and Julia Prentice, PhD
Partnered Evidence-Based Policy Resource Center (AK and JP) and
Health Care Financing & Economics (AK, SP, and JP)