Ambulatory Care Quality Improvement Project



		A.C.Q.U.I.P. Ambulatory Care Quality Improvement Project Funding source Department of Veterans’ Affairs, Health Services Research and Development, Service Directed Research Project Description of work As the Department of Veteran Affairs reorganizes, outpatient care will be an integral, if not the central component of its health care networks. As a result, the need for innovative and effective means of monitoring and improving the quality of care in this setting becomes ever more imperative. Many institutions, including VHA facilities, are finding that traditional methods of quality assurance consume substantial resources but have not been shown to improve patient outcomes. The Ambulatory Care Quality Improvement Project (ACQUIP) is designed to test a new approach to improving quality in the outpatient setting. This approach is consistent with VHA’s emerging adoption of Total Quality Management or Continuous Quality Improvement. The essential features are: Regular assessments by patients about their health, functional abilities and satisfaction with care. Use of an automated information system that contains data on the activities of providers and of their patients including diagnoses, physiologic health, health status and resource utilization. Timely and constructive feedback of information to providers about their patients and practice patterns that is integrated with current clinical guidelines. Training for providers to use this type of information in their routine clinical practice. Simplicity of operation, flexibility, and affordability in a variety of practice settings. The study consists of a multicenter, randomized controlled trial to test the clinical effectiveness of the ACQUIP System. The study will be performed at the General Internal Medicine clinics of six VA facilities, where we will regularly collect data about patients’ health status, satisfaction and overall utilization of outpatient services for a six-month baseline period of observation followed by a two-year period during which the intervention will be conducted. Each participating clinic has established discrete firms, teams or practices that are staffed by different groups of physicians and that care for different patients. At each site, we will randomly select one firm, team or practice to receive the feedback and training intervention and one will serve as a control. The intervention will consist of giving clinicians information about their patients’ medical problems and health status in several ways. At every patient visit, the clinician will receive a graphical summary showing trended physiologic and health status data. These graphical summaries will also incorporate these data into management recommendations that are derived from current clinical guidelines. In addition, clinicians will receive similar reports that show how specific clinical variables, health status and satisfaction of their own panel patients have changed over time compared with the average changes for the clinic as a whole. The routine feedback of these data will be supplemented by training that emphasizes principles of quality improvement and interpretation of health status measures. Providers who belong to firms that receive the intervention will meet regularly with the site investigator to discuss the results of the feedback and to consider methods for improving individual as well as clinic performance. Throughout the study, all sites will be monitored for adherence to study protocols and achievement of specified objectives requisite of continued participation in the study. We will also assess the implementation of the intervention through structured observations and surveys of provider satisfaction. Faculty Stephan D. Fihn, M.D., M.P.H. : Principal Investigator Katherine Bradley, M.D., M.P.H. : Co-Investigator Paula Diehr, Ph.D.: Biostatistician Donald C. Martin, Ph.D.: Biostatistician Thomas Payne, M.D.: Co-Investigator, Computer Consultant Mary McDonell, MS : Project Coordinator Stephen Anderson, MS: Computer Analyst

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