HSR&D Home » Research » CDA 08-024 – HSR&D Study
Optimizing VA Care by Integrating VA Measurement
Adam A. Powell, PhD MBA
Minneapolis VA Health Care System, Minneapolis, MN
Funding Period: October 2010 - January 2014
Over the course of the past two decades VHA has implemented a coordinated set of performance measurement, incentive, and clinical reminder systems to reduce the underuse of preventive health services. The results have been dramatic increases in the use of these services. However, the intense focus on underuse may have pushed the pendulum too far, resulting in overuse of these interventions among patients who are unlikely to benefit and could be harmed. My work seeks to develop an empirically-based understanding of the processes that lead to overuse in the primary care.
(1) Establish a program of research to develop and validate a conceptual framework that elucidates the effects of organizational, provider and patient factors on overuse of preventive health services. (2) Assess the effect of organizational factors on overuse of colorectal cancer screening.
Projects included: (1) a quantitative analysis of VHA administrative data to quantify inappropriate CRC screening rates and to assess relationships between facility-level performance on the CRC screening PM, features of facility CRC screening computerized clinical reminders and inappropriate CRC screening ; (2) a narrative review of literature examining antecedents of overuse in primary care; (3) qualitative patient interviews to explore how clinical reminders and other aspects of the clinical encounter affect overuse and patient-centered care.
Not yet available.
This work will identify processes by which PMs and other system, provider and patient variables influence inappropriate use of CRC screening and other primary care health services. The published framework we developed will provide researchers and practitioners with guidance in designing intereventions to reduce overuse. Findings from this line of research will lead to better methods of measuring care, reduced costs, and more personalized care plans that accommodate each veteran's unique health status and preferences.
External Links for this Project
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DRA: Aging, Older Veterans' Health and Care, Health Systems, Cancer
MeSH Terms: none