Experts Propose Quality Measures for Veterans at High Risk for Adverse Outcomes

In a consensus statement published this week in JAMA Network Open, a panel of 14 health experts and veterans identified what quality measure concepts are important to improve care for veterans at high risk of adverse outcomes in the Veterans Health Administration (VHA).

Veterans’ health is a major population health issue, and significant research is being conducted to help improve veterans’ health outcomes, including efforts to use AI and data analytics to enhance PTSD treatment and bolster access to opioid use disorder treatment through telehealth. However, patient safety is also a top concern for healthcare professionals and advocates in the veterans’ health space.

According to the consensus statement, there is no guidance on what constitutes measurable, high-quality care for veterans with complex health needs, who are most at-risk for adverse outcomes like hospitalization or death. The experts posit that such measures would need to be relevant across multiple disease states and chronic conditions, and identifying such measures can help providers and health systems better design and report on quality improvement efforts.

To identify potential quality measures, the panel extracted 519 relevant concepts for quality measure development in three categories: assessment, management, and other features of healthcare. Measures were extracted from a systematic review of scientific literature that suggested, evaluated, or used indicators of quality care for patients at high risk of adverse outcomes.

Potential measures associated with single conditions, inpatient care, and surgical or other specialty care settings were excluded from consideration. The remaining 63 measures were evaluated by a panel of 10 VHA leaders and staff, two non-VHA physician investigators, and two veterans, who rated each measure from one to nine based on clinical importance. An average rating of 7.5 or higher was used as the cutoff to determine the highest-priority measures.

Overall, potential measures with the highest average rating of 9 focused on caregiver availability and support, COVID-19 vaccination, and pneumonia vaccination. Housing instability was close behind these, with a rating of 8.5.

All other high-priority measures were rated 8, including physical function, depression symptoms, cognitive impairment, prescription regimen, primary care follow-up after an emergency department visit or hospitalization, and timely transmission of discharge information to primary care.

Based on these rankings, the panel recommended annual prescription regimen review, coordinated transitions in care, and preventive care, including vaccinations, as quality measures that have the potential to improve care for veterans at high risk of adverse outcomes. Further, they recommended timely assessments of housing instability, caregiver support, physical function, depression symptoms, and cognitive impairment.

These recommendations come at a time when veterans’ health is facing some significant challenges.

Last week, the Department of Veterans Affairs (VA) Electronic Health Record Modernization (EHRM) program came under scrutiny from the Senate VA committee. The committee raised concerns about whether the program should continue amid patient safety issues, scheduling challenges, and rising costs.

EHR implementation at the VA was paused through the end of the 2021 calendar year due to cost inaccuracies and patient care concerns. These issues were brought back into focus when members of the Senate VA Committee were informed on July 20 that the estimated $16 billion project’s costs over the next 30 years could reach nearly $51 billion after system maintenance and staffing processes were factored in.

VA officials have promised to overhaul the program, but its future remains uncertain.