The Ischemic Heart Disease QUERI

The Quality Enhancement Research Initiative (QUERI) , an initiative of the Health Services Research and Development Service of the Department of Veterans Affairs, is a multidisciplinary, data-driven, national quality improvement program. This Veterans Affairs (VA) initiative is designed to translate research into optimal patient care and systems improvements by identifying best practices, systematizing its use, and providing the ongoing feedback necessary to sustain outcome improvements. Thus, QUERI not only improves individual patient care but also systematically promotes continuous quality improvement at the national level. The Ischemic Heart Disease QUERI is currently one of nine  QUERI groups focusing on diseases of high prevalence and impact in VA. The other eight QUERI groups address colorectal cancer, chronic heart failure, diabetes, HIV/AIDS, mental health, spinal cord injury, stroke, and substance abuse.

To view more information on the QUERI program and the six-step QUERI process,  visit the QUERI homepage.

The Ischemic Heart Disease QUERI

IHD QUERI program description:

Background
Mission
Program Goals:
           Goal 1: Improving the quality of care for veterans with IHD in the acute phase of care
           Goal 2: Improving the quality of care for veterans with IHD in secondary prevention and chronic care management

More information about IHD QUERI:

Project Pipeline
Impacts and Contributions
Fact Sheet
Current Projects

Background
Ischemic heart disease (IHD) is responsible for more than 1 of every 5 deaths in the United States and remains the single largest killer of males and females in the US.  In 2004, the total cost (direct and indirect) for caring for patients with IHD exceeded $133 billion.  Over 500,000 VHA patients have a diagnosis of IHD, a leading cause of mortality and hospitalization for veterans.   Despite advances in care, significant gaps remain in the implementation of best practices for IHD.  Between 10-40% of acute coronary syndrome patients do not receive guideline-indicated therapies at discharge even when they are eligible.  In the VA, data supports that just over half of outpatients with IHD are managed in a manner fully consistent with existing guidelines.

Mission
The overall mission of the Ischemic Heart Disease Quality Enhancement Research Initiative (IHD QUERI) is to improve the quality of care and health outcomes of veterans with IHD by working collaboratively with operational units and other QUERI groups to enable implementation of best practices in acute care, chronic illness care, and secondary prevention. IHD-QUERI has invested substantial effort into forging partnerships with VA leaders to support interventions that both improve care and foster implementation research, including direct collaboration with Patient Care Services, the Office of Quality and Performance, the Office of Information, Employee Education Services, and the National Clinical Practice Guidelines Council. 

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The goals of IHD QUERI and the ongoing efforts to achieve them include:

Goal 1: Improving the quality of care for veterans with IHD in the acute phase of care

2005:

• Continue and update assessment of system-wide variation in acute coronary syndromes, using data collected by OQP through the External Peer Review Program;
• Continue collaboration with OQP, OI, and PCS implementing CART-CL in all VA cardiac catheterization labs and develop proposal for ongoing CART-CL support;
• Continue the evaluation of ACS care in eight VA Medical Centers to assess quality of care and patient outcomes, including health-related quality of life, prospectively;
• Continue the collaboration with PCS to initiate an evaluation of the effects of system-wide change on processes and outcomes of patient care;
• Propose an intervention study to improve inpatient care in acute coronary syndromes in a subset of VA medical centers;
• Develop proposals for expanding CART-CL to include peripheral interventions (conducting angioplasties and stents within the peripheral, rather than coronary, arterial system, such as in the kidneys and other sites) that are increasingly done by VA cardiologists as well as to broader ACS care;
• In collaboration with the Office of Patient Care Services, initiate discussion with the newly forming Emergency Medicine Service about methods of improving initial diagnosis and treatment of ACS within VHA medical centers;
• Continue collaboration with PCS and OQP to engage in external comparisons of VA care with non-VA providers, focusing on registries.

2006-2008

• Complete evaluation of effects of system-wide change on processes and outcomes of patient care;
• Complete evaluation of ACS care using prospective data and propose an intervention to improve health related quality of life for patients with acute coronary syndrome;
• Expand pilot comparisons with external providers and organizations to include all VHA facilities;
• CART-ACS implementation study to examine the effects of implementing a consistent, uniform documentation and reporting system throughout VHA cath labs on patient outcomes and processes of care.

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Goal 2:  Improving the quality of care for veterans with IHD in secondary prevention and chronic care management

2005

• Continue study to encourage best practices in management of chronic stable angina and depression among patients with IHD, through a collaborative care intervention;
• Continue study to evaluate the effectiveness of group visits in controlling hypertension;
• Continue emphasis on post-discharge care for patients with acute coronary syndrome, evaluating gaps in performance across VHA in short and long term follow up for these patients;
• Evaluate the effectiveness of a web-based provider education program for post-MI care in community-based outpatient clinics in VHA and compare with non-VHA settings;
• In collaboration with the Clinical Reminder Subcommittee of the Evidence Based Practice Work Group, assess the completeness and accuracy of the new National IHD Clinical Reminder Database, currently in test.

2006-2008

• Support proposal to test effectiveness of interactive voice response telephone calls in management of hypertension;
• Plan for regional roll-out of best practices in chronic stable angina management;
• Plan intervention study to improve management of depression in IHD;
• Work collaboratively with other research groups to assess impact and sustainability of national electronic clinical reminders.

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                    For more information about IHD-QUERI please contact Mary McDonell at   Mary.McDonell@med.va.gov