Background: Beginning in 1995, the Veterans Health Administration (VHA) reorganized to optimize its healthcare delivery. Among the changes was an increase in the use of ambulatory procedures. Performance measures for tracking changes in ambulatory practice were implemented and served as a basis for rewarding VHA management.
Methods / Design: Data for fiscal years (FY) 1997-1999 were used to analyze patterns of nine categories of procedures across the twenty-two Networks (VISNs) that comprise the VHA healthcare system. Inpatient procedures were defined using the most current version of the Agency for Health Policy and Research (AHCPR) Clinical Classifications for Health Care Policy (CCHPR) grouper for ICD9 codes. Outpatient procedures were derived from Current Procedural Terminology (CPT) codes using the most recent St. Anthony’s CPT short descriptor major section headings. The lists of codes and grouper categories for the targeted procedures were made available to all levels of the organization. Performance measures were defined and system goals established. VISNs were rated on their success in reaching the goals and their degree of deviation from the national pattern. Computer programs identified and eliminated attempts to game the system. Changes in unanticipated hospitalization were reviewed.
Results / Conclusions: There was substantial variation by VISN in the proportion of ambulatory procedures in some categories in FY97. The proportion of ambulatory procedures increased by FY99, and variation in the percentage of ambulatory procedures decreased substantially.
Learning Objectives: At the conclusion of the session, participants will be able to: 1. Identify the components of the VHA’s performance measures for Ambulatory surgical and diagnostic procedures. 2. Describe recent changes in ambulatory practice across the VHA system. 3. Evaluate the importance of changes in ambulatory practice and health-related outcomes
Keywords: Ambulatory Care, Veterans' Health
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Veterans Healthcare Administration
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: employment