Principal Investigator. Quality improvement studies often report that different hospitals or organizations exhibit different levels of baseline readiness to change, such as in terms of planning, resources, and leadership support; and that baseline readiness is a powerful influence on subsequent success or failure of QI implementation. A reliable, valid way of assessing organizational readiness to change could be a useful tool both as a prognostic tool to understand when an organization has a high probability of implementing a new practice, and as a diagnostic tool to identify areas (e.g., planning and goal clarity) where readiness may weak but could be improved. This study builds on a successful pilot grant to conducting scale reliability and factor structure of a survey developed by the VA Ischemic Heart Disease Quality Enhancement Research Initiative. The current study conducts a range of psychometric tests, including combining data from 4 QI studies in the VA using the instrument prospectively; the study will determine if the ORCA scales and subscales predict effective implementation among VA hospitals implementing evidence-based quality improvement practices for depression, schizophrenia, Hepatitis, and eHealth remote access.

Co-Investigator. Develop and validate an automated performance measure for treatment of hyperlipidemia and hypertension in patients with ischemic heart disease using the VA electronic health record (EHR). The ultimate goal is to improve both the quality of care and the efficiency of performance measurement by translating performance measurement from labor intensive manual chart abstraction to automated extraction of continuously updated electronic data. Project active from 2007-2008.

Co-Investigator. Percutaneous coronary intervention (PCI) is a costly clinical procedure that improves outcomes for certain high-risk cardiac patients but also carries a small, but significant risk of adverse outcomes. Recently, "appropriateness" criteria have been developed to help clinicians better identify patients who will benefit from PCI. The Veterans Health Administration is well-positioned to systematically integrate PCI appropriateness via the Cardiac Assessment Reporting and Tracking System - Cath Lab (CART-CL), a software package designed to create a single national VA data repository, procedure reporting, and quality improvement program for procedures performed in the 75 VA cardiac catheterization laboratories. The present study will develop the methods necessary to classify the appropriateness of PCIs performed nationwide in the VA through CART-CL. Project outcomes will be: (1) classification of appropriateness of PCI; (2) identification of data elements necessary for complete appropriateness classification of PCI; and (3) validation of CART-CL data elements for appropriateness classification. Project active from 2007-2011.