J' Perlin VHA Office of Quality

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Measuring Quality Creating VAlue in Health Care
. . . Jonathan B. Perlin, MD, PhD, MSHA,
FACP Chief Quality Performance
Officer, VHA
Value QUALITY Cost
Value OUTCOMES Cost

• Satisfaction
• Functional Status
• Cost-Effectiveness

• VHA Domains-of Value
• Quality
• Access
• Community Health

• Challenge To Create VALUE
• Value Access Technical Functional
  Satisfaction Community Health
• Cost

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Beta Blocker following AMIin VHA Medical Centers
Measurement Accountability
Measurement
Unmeasured Performance
AHCPR Soumerai et al. JAMA 1997277(2)115-21 Non
-Govt Krumholz HM et al. Ann Int Med
1999131(9)648-54
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Pneumococcal Vaccination Rates in VA
Between 1996 1998, increased rates of
pneumococcal vaccination averted 3,914 excess
deaths
Iowa Petersen, Med Care 199937502-9. gt65/ch
dz Extrapolated from Arch Intern Med
19991592437-2442
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Access Geographic Supporting Better Primary Care
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Overall Satisfaction Increased to 91 ACSI 83
Pharmacy, 82 Inpatient, 79 Ambulatory Care
Private sector 68 on 100-point scale
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Summary Since 1995 . . .

• Cost Effectiveness
• -Increased Number of Veterans served by gt38
• -Reduced Cost Per Patient by 24
• Reduced Number of Staff by 27,000
• -Reduced bed-days-of-care by 62
• Reduced hospitalizations by 32
• Increased appropriate ambulatory surgery from7
  to 97
• - Flat budget from 1995-1999, subsequent
• increase lower than inflation, and
• ? Improved Outcomes in ALL Domains !

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Measuring Quality Creating VAlue in Health Care
. . .