Quality and Value of Health Care in the Veterans Health Administration: A Qualitative Study
Background The attitudes of Department of Veterans Affairs (VA) cardiovascular clinicians toward the VA's quality‐of‐care processes, clinical outcomes measures, and healthcare value are not well understood. Methods and Results Semistructured telephone interviews were conducted with cardiovascul...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.011672 |
| _version_ | 1819178755278503936 |
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| author | Andrea G. Segal Keri L. Rodriguez Judy A. Shea Kristina L. Hruska Lorrie Walker Peter W. Groeneveld |
| author_facet | Andrea G. Segal Keri L. Rodriguez Judy A. Shea Kristina L. Hruska Lorrie Walker Peter W. Groeneveld |
| author_sort | Andrea G. Segal |
| collection | DOAJ |
| description | Background The attitudes of Department of Veterans Affairs (VA) cardiovascular clinicians toward the VA's quality‐of‐care processes, clinical outcomes measures, and healthcare value are not well understood. Methods and Results Semistructured telephone interviews were conducted with cardiovascular healthcare providers (n=31) at VA hospitals that were previously identified as high or low performers in terms of healthcare value. The interviews focused on VA providers’ experiences with measures of processes, outcomes, and value (ie, costs relative to outcomes) of cardiovascular care. Most providers were aware of process‐of‐care measurements, received regular feedback generated from those data, and used that feedback to change their practices. Fewer respondents reported clinical outcomes measures influencing their practice, and virtually no participants used value data to inform their practice, although several described administrative barriers limiting high‐cost care. Providers also expressed general enthusiasm for the VA's quality measurement/improvement efforts, with relatively few criticisms about the workload or opportunity costs inherent in clinical performance data collection. There were no material differences in the responses of employees of low‐performing versus high‐performing VA medical centers. Conclusions Regardless of their medical center's healthcare value performance, most VA cardiovascular providers used feedback from process‐of‐care data to inform their practice. However, clinical outcomes data were used more rarely, and value‐of‐care data were almost never used. The limited use of outcomes data to inform healthcare practice raises concern that healthcare outcomes may have insufficient influence, whereas the lack of value data influencing cardiovascular care practices may perpetuate inefficiencies in resource use. |
| first_indexed | 2024-12-22T21:47:35Z |
| format | Article |
| id | doaj.art-be5b8a11c7ac4925836b69bdfadbcdd8 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:47:35Z |
| publishDate | 2019-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-be5b8a11c7ac4925836b69bdfadbcdd82022-12-21T18:11:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-05-018910.1161/JAHA.118.011672Quality and Value of Health Care in the Veterans Health Administration: A Qualitative StudyAndrea G. Segal0Keri L. Rodriguez1Judy A. Shea2Kristina L. Hruska3Lorrie Walker4Peter W. Groeneveld5Department of Veterans Affairs Center for Health Equity Research and Promotion Pittsburgh PADepartment of Veterans Affairs Center for Health Equity Research and Promotion Pittsburgh PADepartment of Veterans Affairs Center for Health Equity Research and Promotion Pittsburgh PADepartment of Veterans Affairs Center for Health Equity Research and Promotion Pittsburgh PADepartment of Veterans Affairs Center for Health Equity Research and Promotion Pittsburgh PADepartment of Veterans Affairs Center for Health Equity Research and Promotion Pittsburgh PABackground The attitudes of Department of Veterans Affairs (VA) cardiovascular clinicians toward the VA's quality‐of‐care processes, clinical outcomes measures, and healthcare value are not well understood. Methods and Results Semistructured telephone interviews were conducted with cardiovascular healthcare providers (n=31) at VA hospitals that were previously identified as high or low performers in terms of healthcare value. The interviews focused on VA providers’ experiences with measures of processes, outcomes, and value (ie, costs relative to outcomes) of cardiovascular care. Most providers were aware of process‐of‐care measurements, received regular feedback generated from those data, and used that feedback to change their practices. Fewer respondents reported clinical outcomes measures influencing their practice, and virtually no participants used value data to inform their practice, although several described administrative barriers limiting high‐cost care. Providers also expressed general enthusiasm for the VA's quality measurement/improvement efforts, with relatively few criticisms about the workload or opportunity costs inherent in clinical performance data collection. There were no material differences in the responses of employees of low‐performing versus high‐performing VA medical centers. Conclusions Regardless of their medical center's healthcare value performance, most VA cardiovascular providers used feedback from process‐of‐care data to inform their practice. However, clinical outcomes data were used more rarely, and value‐of‐care data were almost never used. The limited use of outcomes data to inform healthcare practice raises concern that healthcare outcomes may have insufficient influence, whereas the lack of value data influencing cardiovascular care practices may perpetuate inefficiencies in resource use.https://www.ahajournals.org/doi/10.1161/JAHA.118.011672cardiovascular outcomeshealth services researchhealthcare costsqualitative researchquality of care |
| spellingShingle | Andrea G. Segal Keri L. Rodriguez Judy A. Shea Kristina L. Hruska Lorrie Walker Peter W. Groeneveld Quality and Value of Health Care in the Veterans Health Administration: A Qualitative Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiovascular outcomes health services research healthcare costs qualitative research quality of care |
| title | Quality and Value of Health Care in the Veterans Health Administration: A Qualitative Study |
| title_full | Quality and Value of Health Care in the Veterans Health Administration: A Qualitative Study |
| title_fullStr | Quality and Value of Health Care in the Veterans Health Administration: A Qualitative Study |
| title_full_unstemmed | Quality and Value of Health Care in the Veterans Health Administration: A Qualitative Study |
| title_short | Quality and Value of Health Care in the Veterans Health Administration: A Qualitative Study |
| title_sort | quality and value of health care in the veterans health administration a qualitative study |
| topic | cardiovascular outcomes health services research healthcare costs qualitative research quality of care |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.011672 |
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