- The Institute of Medicine has advocated using performance and outcome measures as a critical tool to improve the quality of care. VA leads the industry in performance measurement through its EPRP, a comprehensive performance measurement system with over 90 indicators across six domains of health care value including quality. VA's investment has significantly improved quality of care, with VA facilities outperforming both the public and private sector. Nevertheless, preliminary analyses from the PI's currently ongoing career development award indicate that, though most measures show improvement over time, there is significant variability across measures. Potential alternative explanations, such as organizational characteristics or 'performing to the test' (i.e. health care facilities tend to concentrate their efforts exclusively on the areas in which they are being measured), are unsupported by these analyses. Research from industrial/organizational psychology suggests that two performance measure characteristics, accomplishment difficulty and documentation difficulty, could considerably bias the validity of a performance measure if not accounted for. In this pilot project we will adapt and develop measures of these characteristics, and test their impact on clinical performance over time. The proposed work could markedly impact the way we measure, monitor, and reward quality of care in the VA and will help to ensure that VA remains a leader in health care quality by more accurately capturing the intended processes and outcomes of care. OBJECTIVES -- The objectives of this pilot research are(1) adapt and develop measures of documentation and accomplishment difficulty of outpatient quality EPRP measures, and (2) to assess the impact of documentation and accomplishment difficulty on VAMC performance trends of these measures. METHODS -- This research is a mixed methods study combining a retrospective database review of selected EPRP with expert ratings of EPRP measure characteristics. Performance measure subject matter experts will convene in focus groups to (a) help develop a measure of accomplishment difficulty and (b) assign ratings of documentation and accomplishment difficulty to a selected set of EPRP measures. We will use these ratings as covariates in latent growth curve analyses of these EPRP measures (acquired via a data use agreement with the Office of Quality and Performance to determine the impact of these measure level characteristics on performance over time.
ANTICIPATED IMPACTS ON VETERAN'S HEALTHCARE -- VA spends millions annually on its External Peer Review Program (EPRP) to maintain a valid, reliable, and useful clinical performance management system;however, this goal depends on the EPRP's ability to accurately capture the phenomena it is designed to assess. Understanding what factors influence facility performance trends is essential to developing strategic, cost-effective, high-impact improvements to care quality. The proposed research specifically examines two overlooked characteristics of EPRP performance measures that could predispose facilities to an upward or downward performance trend. Products of the proposed research could be of significant value to both information technology stakeholders (to help create more user friendly electronic medical record features). and health care policy makers (to devise more effective ways of performing the work that leads to high quality veteran care).