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Infrastructure for quality transformation: measurement and reporting in veterans administration intensive care units
  1. Marta L Render1,2,
  2. Ron W Freyberg1,
  3. Rachael Hasselbeck1,
  4. Timothy P Hofer3,4,
  5. Anne E Sales5,
  6. James Deddens6,
  7. Odette Levesque8,
  8. Peter L Almenoff1,7
  1. 1VA Inpatient Evaluation Center, VAMC–Cincinnati, Cincinnati, Ohio, USA
  2. 2Division of Pulmonary/Critical Care/Sleep, University of Cincinnati, Cincinnati, Ohio, USA
  3. 3VA Health Services Research Center of Excellence, Ann Arbor, Michigan, USA
  4. 4Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
  5. 5University of Alberta, Alberta, Canada
  6. 6University of Cincinnati College of Mathematical Sciences, Cincinnati, Ohio, USA
  7. 7School of Medicine, Division of Pulmonary / Critical Care, University of Kansas, Kansas City, Kansas, USA
  8. 8Veterans Health Administration Operations and Management, Washington DC, USA
  1. Correspondence to Dr Marta L Render, 3200 Vine St. (111f), Cincinnati, OH 45220, USA; marta.render{at}va.gov

Abstract

Background Veterans Health Administration (VA) intensive care units (ICUs) develop an infrastructure for quality improvement using information technology and recruiting leadership.

Methods Setting Participation by the 183 ICUs in the quality improvement program is required. Infrastructure includes measurement (electronic data extraction, analysis), quarterly web-based reporting and implementation support of evidence-based practices. Leaders prioritise measures based on quality improvement objectives. The electronic extraction is validated manually against the medical record, selecting hospitals whose data elements and measures fall at the extremes (10th, 90th percentile). Results are depicted in graphic, narrative and tabular reports benchmarked by type and complexity of ICU.

Results The VA admits 103 689±1156 ICU patients/year. Variation in electronic business practices, data location and normal range of some laboratory tests affects data quality. A data management website captures data elements important to ICU performance and not available electronically. A dashboard manages the data overload (quarterly reports ranged 106—299 pages). More than 85% of ICU directors and nurse managers review their reports. Leadership interest is sustained by including ICU targets in executive performance contracts, identification of local improvement opportunities with analytic software, and focused reviews.

Conclusion Lessons relevant to non-VA institutions include the: (1) need for ongoing data validation, (2) essential involvement of leadership at multiple levels, (3) supplementation of electronic data when key elements are absent, (4) utility of a good but not perfect electronic indicator to move practice while improving data elements and (5) value of a dashboard.

  • Continuous quality improvement
  • evidence-based medicine
  • information technology
  • organization

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Footnotes

  • Funding This program is funded by the Veterans Health Administration of the US Department of Veterans Affairs.

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the University of Cincinnati IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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