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：退伍军人管理局维护内部制度和加强一体化的实施 2019 年 6 月的外部网络 (MISSION) 法案大大增加了退伍军人被推荐的机会 在退伍军人健康管理局 (VHA) 之外进行复杂的心脏手术和手术。 VA 在介入心脏病学和心脏手术质量方面长期处于全国领先地位 因此，增加 VHA 之外的转诊可能会降低退伍军人接受护理的可能性。 心脏手术可以获得最高的护理质量和最佳的手术结果。 意义/影响：随着越来越多的退伍军人现在有资格根据《使命法案》获得 退伍军人事务部以外的主要心脏手术，这对于退伍军人、他们的退伍军人事务提供者和退伍军人事务部来说至关重要 运营领导者充分了解退伍军人在获得护理方面的选择的后果， 护理质量、护理结果和医疗保健费用 VA 社区护理计划的总成本为。 因此，VA 必须最大限度地发挥社区护理资金的价值。 创新：拟议的研究将扩展之前比较 VA 和社区护理服务的研究 主要心脏手术，特别关注 MISSION 法案的影响，该法案有可能 大幅增加在退伍军人管理局以外接受护理的退伍军人数量。我们的研究将为您提供新的见解。 如何通过健康信息更好地了解退伍军人在 VA 和非 VA 提供者之间的选择 护理质量和护理结果，从而加强我们的成本分析将确定。 VA 和非 VA 提供者之间更好的护理协调可以改善双方的潜在机会 通过消除服务差距和减少重复提供护理的价值。 具体目标：本研究的主要目标是：(a) 量化 VA 和非 VA 使用的变化 《使命法案》产生的心脏手术和介入心脏病学服务，重点是如何 获得护理的机会受到影响；(b) 衡量《使命法》的实施对退伍军人比率的影响 获得优质医院的心脏手术和介入心脏病学护理，并比较风险 调整了在退伍军人管理局医院或通过医院接受心脏手术的退伍军人的手术后结果 《使命法案》实施后的社区护理； (c) 简单评估《使命法案》的效果—— 对退伍军人管理局和退伍军人的介入心脏病学和心脏外科护理费用的关注。 方法：本研究将利用我们研究团队在 VA 和非 VA 方面的丰富专业知识 我们将结合 VA 心脏手术和介入的数据。 心脏病学国家登记处，其医疗保健利用率、成本和结果数据保存在 VA 中 企业数据仓库以及 VA 的社区关怀数据集，例如计划完整性工具 我们将重点关注接受 (1) 经皮冠状动脉介入治疗的退伍军人，(2) 冠状动脉。 旁路移植术，(3) 手术瓣膜置换术，或 (4) 经导管主动脉瓣置换术。 退伍军人中最常见的主要心脏手术之一，具有很大的风险 我们将评估该任务的影响。 就退伍军人接受这些程序的机会以及医院提供的心血管护理的质量采取行动 执行这些程序、护理结果以及退伍军人管理局和退伍军人的费用。 实施/后续步骤：该项目的总体目标是证明质量的重要性 和结果信息，以在卫生系统之间做出选择，并确定 VA 的机会 领导力改善护理协调、优化临床结果并降低社区护理成本 我们的研究团队将与 VA 社区办公室的运营合作伙伴密切合作。 护理部和 VA 国家外科办公室共同制定 VA 社区护理计划的未来运作。