Takeaway: The VHA Primary Care Equity Dashboard has become an incredibly powerful and widely used tool for advancing equity-focused quality improvement initiatives on local, regional, and national levels. Since its release, the PCED has achieved incredible reach, having 948 active users based at 119 different VA Medical Centers spanning all 18 VISNs and VA Central Office.
Finding ways to identify and address health disparities that might exist within the VA healthcare system is vitally important to ensuring that all Veterans receive the same high-quality care. The VHA Primary Care Equity Dashboard (PCED) is a multi-faceted tool developed in partnership with the VA Office of Health Equity (OHE) to integrate equity into quality improvement activities within VA primary care settings. Over the course of more than five years, Leslie Hausmann, PhD – a core investigator with HSR&D’s Center for Health Equity Research and Promotion (CHERP) – has led the development and spread of the PCED to help identify and address racial differences in key healthcare metrics, such as immunizations and management of chronic diseases. Dr. Hausmann has identified the clinical tools and practices needed to address the disparities that are quantified and displayed on the dashboard.
“Right now, people learn about quality improvement in general, but that’s often not done through the health equity lens. This tool will shine a very bright light on the health equity component to make that shift.” —Dr. Leslie Hausmann (PittMed, 2021)
With support from the VA Innovators Network – and using VA data, Dr. Hausmann led the development of a prototype, then secured funding (from the Office of Health Equity and HSR&D’s RIVRs program) for a five-year project that focuses on streamlining the PCED so it can be leveraged as a quality improvement tool in VA facilities nationwide. The dashboard allows a facility to see where they stand in quality measures – and to compare themselves to other VA medical centers across the country. It also allows for the identification of which demographic groups need attention and exactly which patients need contacting. From there, dashboard users can access resources to figure out what concrete steps to take next. For example, a tab within the dashboard contains a vast library of quality-improvement tools and resources, carefully culled from the medical literature and organizations aimed at addressing disparities.
“If you don’t measure it, you can’t change it, so our dashboard is designed to provide feedback that clinical leaders can use to understand the equity of care delivered in real time; the idea being that without this kind of information there will be no incentive to change.” —Peter Groeneveld, Core Investigator, CHERP (Penn Today, 2022)
Dr. Hausmann and colleagues have compiled dozens of toolkits, roadmaps, and evidence-based interventions for addressing disparities in the treatment of specific diseases—some focus on patients, some focus on providers.
Research to Impact for VeteRans (RIVRs)
The RIVRs program is a new HSR&D funding mechanism that gives researchers the opportunity to pursue a five-year impact goal. Each RIVR impact goal aligns with VA priority areas, including VA legislative priorities (i.e., MISSION Act), cross-cutting VA Office of Research & Development (ORD) priorities (i.e., PTSD), methodological priorities (e.g. data sciences, implementation sciences), and other clinical priorities including health equity. Impact goals for RIVRs could include changes in VA policy or clinical guidelines, spread of operational processes across VISNs, scaling of an effective intervention, or any other impacts that have real-world effects on the health and care of Veterans.
The impact goal for the Primary Care Equity Dashboard is to integrate equity into evidence-based quality improvement efforts starting in VISN4. To accomplish this goal, investigators developed instructional materials for using an interactive disparities dashboard that was developed in partnership with the OHE to identify racial/ethnic, gender, and/or rural/urban disparities in VA quality measures at both the VISN and local levels. A team led by Dr. Hausmann also facilitated, tested, and evaluated the use of the PCED in multiple equity-focused QI initiatives in VISN4. These demonstration projects informed the creation of a master facilitator’s guide for assisting QI teams with incorporating the disparities dashboard into their workflow. To support the spread of this practice beyond VISN4, investigators are using the guide to train OHE staff as facilitators of equity-focused quality improvement at VA facilities across the nation.
Expanded reach of this program will be accomplished by producing tools and processes that can be extended to other VISNs and Veteran populations at risk for disparate healthcare, including those who are homeless or have serious mental illness.
As this RIVR program enters its fifth year, PCED is available to staff in every VA Medical Center and has become an incredibly powerful and widely used tool for advancing equity-focused QI initiatives on local, regional, and national levels. Since its release, PCED has achieved phenomenal reach, having 948 active users based at 119 different VA Medical Centers spanning all 18 VISNs and VA Central Office.
In addition, the PCED team has created several durable resources to support uptake and dissemination, including an introductory tutorial available through TMS (Training Management System) for continuing medical education credits, case studies, webinars, and a guide for facilitating implementation of equity-focused QI using the PCED. These resources can be accessed from within the VA firewall on the PCED SharePoint Site (VA network access only: https://dvagov.sharepoint.com/sites/VACOVHAOHE/SitePages/Test.aspx). With OHE’s increased capacity, Dr. Hausmann will also train OHE staff to deliver technical support to PCED users.
Burkitt K, Rodriguez K, Mor M, Fine M, Clark W, Macpherson D, Mannozzi C, Muldoon M, Long J, and Hausmann L. Evaluation of a collaborative VA network initiative to reduce racial disparities in blood pressure control among Veterans with severe hypertension. Healthcare. June 2021;8(1):100485.
Moy E, Hausmann L, Clancy C. From HRO to HERO: Making health equity a core system capability. American Journal of Medical Quality. Jan-Feb 2022;37(1):81-83.
Haussmann L. Partnered research supports the use of equity-guided improvement to reduce disparities among Veterans. FORUM. Fall 2021.