Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

2004 — Population Health in Veterans with Diabetes: Implementing a New Approach to Quality Measurement

Litaker DG (Louis Stokes Cleveland VAMC) , Aron DC (Louis Stokes Cleveland VAMC), Pogach L (East Orange VAMC), Miller DR (Bedford VAMC), Vijan S (Ann Arbor VAMC), Watts B (Louis Stokes Cleveland VAMC)

Workshop Objectives:
The quality of diabetes care veterans receive varies substantially, despite its high prevalence in veterans, its negative consequences on their quality of life, and the value of aggressive management of vascular risk factors. Current quality indicators rely on thresholds (e.g., >9% for poor glycemic control; <7% for optimal glycemic control; attainment of systolic blood pressure <130 mm Hg; LDL-c values <100 mg/dL), yet measures that better reflect the complex epidemiology of diabetes are needed to more accurately guide deployment of resources for quality improvement efforts in specific systems of care or at specific sites of care. Recent development of predictive models like the United Kingdom Progression of Diabetes Study (UKPDS) risk engine offer promise in achieving these objectives. This workshop will provide participants with a better understanding of the strengths and limitations of current strategies to quality measurement; discuss measurement options, including composite measures, measures capturing improvement across a continuum of risk factor control, longitudinal measures, and weighting schemes that can be used to better reflect the epidemiology of diabetes; demonstrate the utility of the UKPDS and other currently available risk engines; enumerate the methodological challenges and potential solutions that might be encountered in the implementation phase; evaluate the limitations of the available risk engines in terms of generalizability outside a clinical trial setting, long-term utility of these tools for quality measurements and tradeoffs in their implementation.

a) Didactic session outlining current conceptual frameworks for quality measurement and current recommendations on the characteristics of acceptable quality measures, b) Demonstration of the UKPDS and other currently available risk engines using cross-sectional data from the VA’s Diabetes Epidemiology Cohort (DEpiC) to generate quality measurements, c) Panel discussion on strategies for dealing with common methodological challenges including those identified by attendees and potential future directions for quality measurement in the VA (e.g., longitudinal modeling of intermediate outcomes and comorbidity adjustment approaches).

Target Audience:
Health services researchers interested in advancing quality measurement and administrators/managers seeking efficient strategies to deploy quality improvement efforts for enhancing veteran health system-wide.

Assumed Audience Familiarity with Topic:
Participants should have a familiarity with the VA health care system.