Assessing compliance with national quality measures to improve colorectal cancer care at the VA

BackgroundThe US Department of Veterans Affairs (VA) Office of Quality and Performance's July 2009 report detailed the quality of VA colorectal cancer (CRC) care on the basis of 10 quality indicators (QIs). Of 21 Veterans Integrated Service Networks (VISNs), the authors' VISN ranked last or near last on more than half of the QIs. The aim of this study was to compare a national-level assessment of performance with an institutional-level clinical review.MethodsThe authors reabstracted all patients seen at surgical hospitals within their VISN during the time period of the Office of Quality and Performance report and reanalyzed their performance on the 10 QIs. A number of quality improvement efforts were also implemented to further boost performance, including the creation of a computerized patient record system CRC order set and quarterly surveillance meetings.ResultsAfter reanalysis of the VISN's QI performance for CRC patients during the time period of the OQP report, the VISN performed 18% better than reported and 2% better than the national average. Since that time, a multidisciplinary CRC committee has implemented quality improvement measures that have further improved QI performance.ConclusionsThere is variability between administrative quality assessments and clinically abstracted data. Care must be taken when analyzing QIs at the national level.