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VA's National Performance Measurement System Reveals Gaps in Timely Communication of Test Results to Veterans


BACKGROUND:
Failure to communicate test results to patients remains a persistent problem that can lead to diagnosis and treatment delays, with up to 62% of abnormal laboratory and 36% of abnormal radiology results lacking timely follow-up. Thus, VA developed a national policy in 2015 stating that ordering providers must communicate abnormal test results to Veterans within 7 days if action is required and within 14 days if no action is required or results are normal. VA’s performance measurement system – the External Peer Review Program (EPRP) – subsequently created multiple measures of timeliness of test results communication to Veterans in accordance with the directive. Investigators in this study analyzed the first full year of these measures in a sample including all 141 VA facilities to determine VA’s timeliness in communicating test results to Veterans. They also evaluated one relevant item from the Survey of Healthcare Experiences of Patients (SHEP), in which Veterans were asked how often someone from their provider’s office followed up to give them their test results in the last 6 months, and compared these findings with the EPRP data.

FINDINGS:

  • EPRP measures showed timely communication for 71% of abnormal; 80% of normal; and 82% of all test results within 30 days.
  • Performance varied by facility: timely communication ranged between 46-94% for abnormal, 53-97% for normal, and 59-95% for all
  • Performance also varied by test; for example, for abnormal tests, results were communicated to Veterans least often in a timely way for DEXA scans (62%) and most often for chest x-rays (85%).
  • SHEP data showed that 8% of Veterans reported test results were “never” communicated; 6% said “sometimes;” 16% said “usually;” and 70% said test results were “always” communicated. This also varied by facility; for example, Veterans reporting results were “never” communicated ranged from 3-24%, while Veterans reporting results were “always” communicated ranged from 51-84%.

IMPLICATIONS:

  • VA’s national performance measurement system revealed gaps in timely communication of test results to Veterans. Communication gaps varied by facility, emphasizing the need for local quality improvement efforts to address contextual factors that may impact follow-up (e.g., local workflows or team support for test result management). Using these measures for accountability rather than just for quality improvement may be an important consideration.

LIMITATIONS:

  • Study data relied on documentation and do not reveal all aspects of communication quality.
  • Data may not fully capture Veteran care external to the VA system.

AUTHOR/FUNDING INFORMATION:
Dr. Meyer is supported by an HSR&D Career Development Award. Drs. Meyer and Singh and Ms. Scott are part of HSR&D’s Center for Innovations in Quality, Effectiveness and Safety (IQuESt) in Houston, TX.


Meyer AND, Scott TMT, and Singh H. Adherence to National Guidelines for Timeliness of Test Results Communication to Patients in the Veterans Affairs Health Care System. JAMA Network Open. April 22, 2022;5(4):e228568.

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HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.


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