Impact of the MISSION Act on Quality and Outcomes of Interventional Cardiology and Cardiac Surgery among Veterans

《使命法案》对退伍军人介入心脏病学和心脏手术的质量和结果的影响

• 批准号: 10640085
• 负责人: PETER W. GROENEVELD
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10640085
• 关键词: Accounting; Address; Administrator; Affect; Cardiac; Cardiac Surgery procedures; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Catheterization; Clinical; Clinical Data; Clinical assessments; Colorado; Community Healthcare; Community Hospitals; Complex; Coronary Artery Bypass; Cost Analysis; Data; Data Analyses; Data Set; Databases; Decision Making; Diagnosis; Dimensions; Eligibility Determination; Enrollment; Event; Fees; Funding; Future; Goals; Health Care Costs; Health Personnel; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Heart Diseases; Hospitals; Information Resources; Interdisciplinary Study; Intervention; Joints; Laboratories; Leadership; Measures; Medical; Medical center; Medicare claim; Methodology; Morbidity - disease rate; Office Surgery; Operative Surgical Procedures; Outcome; Outcomes Research; Pathway interactions; Patient Care; Patients; Performance; Philadelphia; Policy Maker; Probability; Procedures; Process; Provider; Quality of Care; Registries; Reporting; Research; Research Personnel; Resources; Risk Adjustment; Services; Shapes; Surgical Valves; System; Time; Travel; Veterans; Veterans Health Administration; Work; aortic valve replacement; cardiology service; care coordination; care costs; care outcomes; care providers; cost; data registry; data resource; data warehouse; experience; health care availability; health care quality; health care service; health care service utilization; health economics; improved; innovation; insight; intervention cost; mortality; mortality risk; multidisciplinary; novel; operation; patient registry; percutaneous coronary intervention; procedure cost; programs; readmission rates; tool; valve replacement

Background: The implementation of the VA’s Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act in June of 2019 greatly expanded opportunities for Veterans to be referred outside of the Veterans Health Administration (VHA) for complex cardiac procedures and surgeries. However, the VA has been a longstanding national leader in both interventional cardiology and cardiac surgical quality of care. Hence, increased referrals outside of the VHA may reduce the probability that Veterans undergoing cardiac procedures receive the highest care quality and the best procedural outcomes. Significance/Impact: With increasing numbers of Veterans now eligible under the MISSION Act to obtain major cardiac procedures outside VA, it is critically important for Veterans, their VA providers, and VA operational leaders to fully understand the consequences of Veterans' choices in terms of their access to care, quality of care, outcomes of care, and health care costs. The total costs of VA's Community Care program are substantial; it is therefore essential that VA maximizes the value from funds expended on Community Care. Innovation: The proposed research will extend prior studies comparing VA and Community Care provision of major cardiac procedures with a specific focus on the impact of the MISSION Act, which has the potential to vastly expand the number of Veterans receiving care outside VA. Our research will provide novel insight into how Veterans’ choices between VA and non-VA providers could be better informed by information about health care quality and outcomes of care, thus enhancing the decision-making process. Our cost analysis will identify potential opportunities where better care coordination between VA and non-VA providers could improve both the value of care delivered by eliminating gaps in, and reducing duplication of, services. Specific Aims: The primary objectives of this study are to: (a) quantify the changes in use of VA and non-VA cardiac surgery and interventional cardiology services resulting from the MISSION Act, with a focus on how access to care was affected; (b) measure the effects of MISSION Act implementation on the rates Veterans obtain cardiac surgery and interventional cardiology care from high-quality hospitals, and compare the risk- adjusted post-procedure outcomes among Veterans obtaining cardiac procedures in VA hospitals or via Community Care after the MISSION Act was implemented; (c) assess the effect of MISSION Act imple- mentation on the cost of interventional cardiology and cardiac surgical care to both the VA and to Veterans. Methodology: This study will leverage our research team’s substantial expertise with both VA and non-VA clinical, administrative, and cost datasets. We will combine data from VA’s cardiac surgery and interventional cardiology national registries with health care utilization, cost, and outcomes data housed in the VA’s Corporate Data Warehouse, as well as VA’s Community Care datasets such as the Program Integrity Tool database. We will focus on Veterans undergoing (1) percutaneous coronary intervention, (2) coronary artery bypass grafting, (3) surgical valvular replacement, or (4) transcatheter aortic valve replacement. These are among the most common major cardiac procedures performed among veterans, with substantial risk of mortality and morbidity as well as high associated health care costs. We will assess the impact of the MISSION Act on Veterans’ access to these procedures, the quality of cardiovascular care delivered by the hospitals performing these procedures, the outcomes of care, and the costs to both VA and to Veterans. Implementation/Next Steps: The project's overarching goals are to demonstrate the importance of quality and outcomes information in making choices between health systems, and to identify opportunities for VA leadership to improve care coordination, optimize clinical outcomes, and reduce costs in the Community Care program. Our research team will work closely with our Operational Partners in the VA's Office of Community Care and the VA's National Surgery Office to shape the VA Community Care Program’s future operations.

背景：VA维护内部系统的实施并加强综合 2019年6月，外部网络（Mission）法案大大扩大了退伍军人的机会 在退伍军人卫生管理局（VHA）之外进行复杂的心脏手术和手术。然而， VA一直是介入心脏病学和心脏外科质量的长期国家领导者 关心。因此，在VHA之外的推荐人数增加可能会降低退伍军人经历的可能性 心脏手术获得最高的护理质量和最佳的进度结果。 意义/影响力：随着越来越多的退伍军人符合《任务法》的资格 弗吉尼亚州以外的主要心脏程序，这对于退伍军人，他们的VA提供商和VA至关重要 操作领导人完全了解退伍军人选择的后果 护理质量，护理结果和医疗保健费用。 VA社区护理计划的总费用是 重大的;因此，VA必须从社区护理中探索的资金中最大化价值。 创新：拟议的研究将扩展比较VA和社区护理提供的先前研究 主要的心脏程序，特别关注《任务法》的影响，这有可能 大大扩大了在弗吉尼亚州以外接受护理的退伍军人人数。我们的研究将为您提供新颖的见解 关于健康的信息，如何更好地了解VA和非VA提供商之间退伍军人的选择 护理质量和护理结果，从而增强了决策过程。我们的成本分析将确定 VA和非VA提供商之间更好的护理协调可以改善两者的潜在机会 通过消除服务的差距并减少服务重复来提供的护理价值。 具体目的：本研究的主要目标是：（a）量化VA和非VA的使用更改 《任务法》引起的心脏手术和介入心脏病学服务，重点是 进入护理受到影响； （b）衡量实施任务法对退伍军人的影响 从高质量医院获得心脏手术和介入心脏病学护理，并比较风险 - 在VA医院或通过 执行任务法案后的社区护理； （c）评估任务法的影响 - 提及VA和退伍军人的介入心脏病学和心脏手术护理的成本。 方法论：本研究将利用我们的研究团队在VA和非VA中的大量专业知识 临床，行政和成本数据集。我们将结合VA心脏手术和介入的数据 心脏病学国家注册机构具有卫生保健利用，成本和成果数据的数据 公司数据仓库以及VA的社区护理数据集，例如程序完整性工具 数据库。我们将专注于接受（1）经皮冠状动脉干预的退伍军人，（2）冠状动脉 旁路移植，（3）手术瓣膜置换，或（4）经导管主动脉瓣置换。这些都是 在退伍军人中执行的最常见的主要心脏手术中，有很大的风险 死亡率和发病率以及高相关的医疗保健费用。我们将评估任务的影响 对退伍军人访问这些程序，医院提供的心血管护理质量 执行这些程序，护理结果以及VA和退伍军人的成本。 实施/下一步：项目的总体目标是证明质量的重要性 以及在卫生系统之间做出选择的结果，并确定VA的机会 提高护理协调，优化临床结果并降低社区护理成本的领导能力 程序。我们的研究团队将与弗吉尼亚州社区办公室的运营合作伙伴紧密合作 护理和VA国家手术办公室塑造VA社区护理计划的未来运作。