Turning an armada VHA Ischemic Heart Disease Quality Enhancement Research Initiative Quality Enhancement Research Initiative

The VHA Cardiac Care Initiative Sparked by an external review of cardiac care in VHA completed in early 2003 –Findings uncomplimentary to VHA Intense activity and scrutiny at the highest levels of the organization

Dimensions of VHA as an integrated system 1300 facilities spread across the United States –163 Medical Centers –850 Ambulatory Care and Community Based Outpatient Clinics –206 Counseling Centers –137 Nursing Homes –43 Domiciliaries Serve over 6.5 million veterans –Out of 26.5 million veterans total in 2000 census –38% of veterans are 65 or older –Higher proportion of VA users are 65 or over

VHA is divided into 21 VISNs

Ten part initiative AMI Directive VISN/Facility AMI plans Cardiology clinical practice guideline update Cardiac care education programs for patients and providers Blue Ribbon Panel to review work Changes to the External Peer Review Program New Performance Measures Explore nuclear cardiology and tele- cardiology Infrastructure assessment and improvement Cardiac Care Follow-up Clinical Study

Current Status AMI directive issued April 2003; VISNs and facilities produced plans by July 2003; Evaluation and monitoring of plan implementation ongoing –Patient level data on all inpatients discharged with dx of AMI or unstable angina –Phone interviews with over 160 individuals at more than 80 hospitals –Web based survey of Chiefs of Cardiology and Medicine to be fielded this fall –Risk adjustment model for mortality and other outcomes completed –Process mapping to diagnose gaps in performance on key measures –Developing a toolkit to improve rates of and times to reperfusion for patients with ST segment elevation MI