Health Services Research & Development

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JGIM Supplement Features Ten Articles by VA Researchers on Next Generation Clinical Performance Measures

March 28, 2016

Funded by VA's Health Services Research and Development (HSR&D) Service, this Journal of General Internal Medicine (JGIM) Supplement is the product of an HSR&D sponsored state-of-the-art (SOTA) conference titled "Next Generation Clinical Performance Measures: Patient-Centered, Clinically Meaningful, and High-Value," which was held in 2014. A Call for Papers was issued following the SOTA, and 10 articles were accepted for publication in this special Supplement. Published papers discuss empirical research on the effects of performance measurement on improvements in clinical care, as well as on unintended outcomes (e.g., inappropriate treatment or over-treatment). Papers also describe new methods and methodological challenges in the selection and creation of performance measures that incorporate measures of benefit and harm, value, or patient preferences, and also present research on the implementation of performance measures that address human factors, incentives and facilitators, barriers, and expected and unintended consequences. A few of the measures and findings discussed include:

  • Phibbs and colleagues developed stroke electronic clinical quality measures that are part of the Meaningful Use (MU) program to improve inpatient stroke care. They found that stroke MU indicators can be accurately generated from existing VA electronic health record (EHR) data, with nearly a 90% match to chart review.
  • Farmer and colleagues developed electronic, population-based quality metrics for depression care. They found that despite rapid growth in the primary care population in VA from FY2000-2010, the detection of new episodes of depression (8%) and minimally appropriate treatment rates (84%) remained stable. This suggests that VA was able to maintain a standard of care while treating significantly more patients each year.
  • Harris and colleagues implemented a substance use disorder continuity-of-care quality measure in VA Network Directors' performance contracts, and found it was associated with an increase in measured performance from 23% before the measure was implemented to 48% by the end of the study.

Journal of General Internal Medicine. April 2016;31(1 Suppl):1497-1525. Free online access is available via VA computers only.