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*284. Using an Improvement Model to Reduce Adverse Drug Events in VA Facilities

WB Weeks, Director, VISN 1 Patient Safety Center of Inquiry, Hub Site Senior Scholar, VA Quality Scholars Program, WRJ VAMC and Dartmouth Medical School; PD Mills, Associate Director, VISN 1 Patient Safety Center, WRJ VAMC and Dartmouth Medical School; RS Dittus, Senior Scholar, VA Quality Scholars Program, Nashville VAMC and Vanderbilt University; DC Aron, Senior Scholar, VA Quality Scholars Program, Cleveland VAMC and Case-Western Reserve; PB Batalden, VA Quality Scholars Program and Dartmouth Medical School

Objectives: In collaboration with the Institute for Healthcare Improvement, the Veterans Health Administration delivered a seven-month facilitated, team-based quality improvement effort designed to reduce adverse drug events. The purpose of this study was to determine the results of the quality improvement effort on patient care, to identify team characteristics that were related to success, and to determine whether participation in the effort might have generated cost savings.

Methods: Using a before-after design, we used three methods to evaluate the outcomes of the quality improvement effort: an objective evaluation of the types of projects undertaken and teamsí progress toward goals, a 12 item self-report survey, and teamsí self-reported outcome measures. We generated a financial model for the educational quality improvement series that examined two scenarios: one in which improvements and the resources committed to them stopped at the end of the effort, and one in which they continued for three years. Potential cost savings were estimated using cost estimates for the interception of potential adverse drug events during the collaborative effort and estimates of avoidance of legal costs extracted from a VA torts claim database. Using standard financial techniques, we determined two measures of return on investment for participation in the quality improvement effort.

Results: 27 teams participated in the effort, focusing on 9 medication delivery issues. 52% of the teams made improvements of at least 20% that were sustained for at least two months during the quality improvement effort. Teams that achieved the highest faculty scores were involved in conference calls prior to the first face-to-face meeting (r=0.398, p< 0.040), completed early requests for documented changes (r=0.518, p< 0.006), and reported that they "learned new ideas" in the first learning session (r = 0.4877, p < 0.014). Despite a sense of support from top local leadership, teams did not feel that they had enough time or resources to achieve their goals. This sense became more apparent by the end of the collaborative effort.

The teams collectively reported 1831 fewer medication errors with the potential to cause adverse effects than would have been expected from their baseline data. Depending on the scenario examined, the annual return on the investment in the educational series ranged from 13% to 302% and that the net present value of the investment ranged from $51,000 to $27 million.

Conclusions: A focused, facilitated quality improvement designed to reduce adverse drug events within the VA system was effective in teaching teams about reducing adverse drug events, enlisting teams to make changes that would help reduce adverse drug events, and reducing medication errors that have the potential to cause adverse events. This effort appeared to generate cost savings. Our findings suggest that the incremental return investment is higher for sustaining changes than for initiating changes.

Impact: The assessment of the impact of quality improvement efforts is important, and return on investment is one way to assess such efforts. In this case, returns on investment were greater when the investment was extended than for the time period of the quality improvement effort.