November 1, 2002
WASHINGTON - The Department of Veterans Affairs (VA) was praised this week in an Institute of Medicine (IOM) report for its initiatives to improve the quality of health care.
"VA is a national leader in developing quality measurements to provide the best health care for our veterans," said Secretary of Veterans Affairs Anthony J. Principi. "Both health care and veteran satisfaction have improved as a result of our quality improvements." The IOM report, entitled Leadership by Example, lauded VA's use of performance measures to improve quality in clinical disciplines and in ambulatory, hospital and long-term care.
"VA's integrated health care information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation," according to the IOM.
The IOM report also cited VA's National Surgical Quality Improvement Program (NSQIP), which uses performance measurements, reports, self-assessment tools, site visits, and best practices. It develops risk-adjusted information on surgical outcomes in the VA's medical centers. From 1991, when NSQIP data were first collected, to 2000, the impact on the outcomes of major surgeries was dramatic: 30-day post-operative deaths decreased by 27 percent.
Just this year, the Houston VA Medical Center (HVAMC) accepted the NSQIP award for having the second lowest risk adjusted mortality rate among 123 VA Medical Centers nationwide. The HVAMC boasts a surgical staff that performs over 5,000 surgical procedures each year and represents nine surgical subspecialties. These include general surgery, cardiac surgery, neurosurgery, orthopedic surgery, plastic surgery, urology surgery, vascular surgery, otolaryngology, and gynecology. In addition, the HVAMC Cardiac Surgery Section received recognition this year as a "Clinical Program of Excellence" within the Veterans Health Administration (VHA).
VA's electronic medical record system and Bar Code Medication Administration (BCMA) program are essential tools for improving health care quality and patient safety. Earlier this year, the BCMA program won the 2002 Pinnacle Award, a top honor by the American Pharmaceutical Association Foundation. The BCMA program allows a nurse or other health care provider to make sure that a patient is receiving the correct medication in the correct dose at the correct time. This week, HVAMC began use of Version 2.0 of the BCMA system. This version will allow point-of-care in high-risk intensive care situations.
Also this year, VA's National Center for Patient Safety (NCPS) received the John E. Eisenberg Award in Patient Safety for System Innovation. The Eisenberg awards are given by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and the National Forum for Healthcare Quality and Reporting (NQF).
VA's patient safety program relies on a method that combines voluntary and mandatory reporting systems, root cause analysis, and corrective actions to improve patient safety. VA's programs have been adopted in Australia, Japan, and Denmark, among others.
To help maintain its position at the leading edge of performance measurement and quality improvement, VA recently established a new leadership position in its health care system, appointing Dr. Frances M. Murphy as the deputy under secretary for health policy coordination. Murphy is responsible for coordinating a wide range of health care issues with the Department of Health and Human Services, including health care quality, patient safety, occupational health and safety, and information technology.
"The U.S. can no longer practice 20th century medicine. Government needs to lead the metamorphosis to 21st century patient-centered quality health care through better use of health information technology," said Murphy. "Consistent, publicly reported quality measurement is essential to improve health care delivery and patient satisfaction. The technology is readily available, inexpensive and reliable."
VA's Quality Program ensures system-wide delivery of health care based on the best scientific evidence for clinical practice and explicit accountability of management and clinicians as a strategy for fulfilling VA's mission to be the health care provider of choice for America's veterans. VA's performance measurements show VA health care is the current benchmark in quality for numerous areas when compared with other health care systems.
The IOM report analyzed quality enhancement processes in six government programs - the VA, Medicare, Medicaid, the State Children's Health Insurance Program, the Department of Defense TRICARE and TRICARE for Life programs, and the Indian Health Services program. Information about the IOM report can be obtained at http://www.iom.edu/.
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Point of Contact: VHAHOU Public Affairs04/21/04 08:25