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VA RESEARCH QUARTERLY UPDATE
This Issue: Ensuring High-Quality Care | Table of Contents: Fall 2017 | Download this issue

Noteworthy Publications

Use of performance measures for selecting community surgical providers


The VA Office of Community Care is reviewing performance metrics to rate heart surgeons who wish to participate in the Veterans Choice program. <em>(Photo ©iStock/baranozdemir)</em>
The VA Office of Community Care is reviewing performance metrics to rate heart surgeons who wish to participate in the Veterans Choice program. (Photo ©iStock/baranozdemir)

The VA Office of Community Care is reviewing performance metrics to rate heart surgeons who wish to participate in the Veterans Choice program. (Photo ©iStock/baranozdemir)

The VA Office of Community Care is considering using performance metrics to make it easier to select qualified orthopedic and cardiac surgical providers for inclusion in the Veterans Choice program. Unfortunately, while there are many indirect indicators of patient well-being following surgery, they are not enough to predict good surgical outcomes.

To address this problem, VA researchers from the Evidence-based Synthesis Program Coordinating Center in Portland, Oregon, conducted a rapid evidence review to find out if the medical literature supported an association between performance metrics and health outcomes.

They concluded that the all-cause 30-day hospital readmission rate was a moderately strong indicator of death within 30 days for coronary bypass surgery. It is a weaker indicator of death after hip replacement, but is a consistent metric. Also, the researchers noted that it would be relatively easy to collect data on this metric, as Medicare providers are required to report on 30-day readmissions. 

Despite some limitation, the researchers proposed that 30-day readmission is the best indicator of surgical outcomes and could be included as a prerequisite for participation in the Veterans Choice surgical program. In addition, they suggested that these metrics should also be included as minimum requirements for inclusion in the Choice program:

  • An acceptable performance on national rankings.
  • The use of compatible operational infrastructure.
  • The ability to comply with an agreed-upon wait-time threshold.

The Veterans Choice program was created in 2014 to give Veterans better access to health care by approving community care in certain circumstances—i.e., when there are long wait times to see a VA provider or patients live more than 40 miles from a VA health care facility. The Choice program also stipulated that community providers must maintain the same credentials as VA providers and enter into agreements with VA to furnish care, rather than use a voucher-like system.



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