Portal de Periódicos da CAPES

Creating a Culture of Quality: The Remarkable Transformation of the Department of Veterans Affairs Health Care System

2004; American College of Physicians; Volume: 141; Issue: 4 Linguagem: Inglês

10.7326/0003-4819-141-4-200408170-00013

1539-3704

Sheldon Greenfield, Sherrie H. Kaplan,

Healthcare Policy and Management

Editorials17 August 2004Creating a Culture of Quality: The Remarkable Transformation of the Department of Veterans Affairs Health Care SystemSheldon Greenfield, MD and Sherrie H. Kaplan, PhD, MPHSheldon Greenfield, MDFrom University of California, Irvine, Irvine, CA 92697. and Sherrie H. Kaplan, PhD, MPHFrom University of California, Irvine, Irvine, CA 92697.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-4-200408170-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail For decades, fairly or unfairly, the Department of Veterans Affairs (VA) health care system had a suboptimal image in the quality of care it provided and in the evaluation of that care. About 10 years ago, the VA leadership began a major national reorganization that has transformed the VA health care system. What was largely an inpatient, subspecialty-based system became a "full-service," integrated delivery system committed to a new model of health promotion, disease prevention, and coordination of care. The VA's transformation was 2-part. First, it implemented a sweeping overhaul of service delivery. Second, it created a "culture of quality," ...References1. Kizer KW, Demakis JG, Feussner JR. Reinventing VA health care: systematizing quality improvement and quality innovation. Med Care. 2000;38:I7-16. [PMID: 10843266] CrossrefMedlineGoogle Scholar2. Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. N Engl J Med. 2003;348:2218-27. [PMID: 12773650] CrossrefMedlineGoogle Scholar3. Kerr EA, Gerzoff RB, Krein SL, Selby JV, Piette JD, Curb JD, et al . Diabetes care quality in the Veterans Affairs health care system and commercial managed care: the TRIAD study. Ann Intern Med. 2004;141:272-81. LinkGoogle Scholar4. Reiber GE, Boyko EJ, Maynard C, Koepsell TD, Pogach LM. Diabetes in the Department of Veterans Affairs. Diabetes Care. 2004;27 Suppl 2 B1-2. [PMID: 15113775] CrossrefMedlineGoogle Scholar5. Hayward RA, Hofer TP, Kerr EA, Krein SL. Quality improvement initiatives: issues in moving from diabetes guidelines to policy. Diabetes Care. 2004;27 Suppl 2 B54-60. [PMID: 15113784] CrossrefMedlineGoogle Scholar6. Fleming BB, Greenfield S, Engelgau MM, Pogach LM, Clauser SB, Parrott MA. The Diabetes Quality Improvement Project: moving science into health policy to gain an edge on the diabetes epidemic. Diabetes Care. 2001;24:1815-20. [PMID: 11574448] CrossrefMedlineGoogle Scholar7. National Diabetes Alliance. Accessed at www.nationaldiabetesalliance.org on 7 July 2004. Google Scholar8. Greenfield S, Kaplan SH, Kahn R, Ninomiya J, Griffith JL. Profiling care provided by different groups of physicians: effects of patient case-mix (bias) and physician-level clustering on quality assessment results. Ann Intern Med. 2002;136:111-21. [PMID: 11790062] LinkGoogle Scholar9. Krein SL, Hofer TP, Kerr EA, Hayward RA. Whom should we profile? Examining diabetes care practice variation among primary care providers, provider groups, and health care facilities. Health Serv Res. 2002;37:1159-80. [PMID: 12479491] CrossrefMedlineGoogle Scholar10. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002;288:1909-14. [PMID: 12377092] CrossrefMedlineGoogle Scholar11. Weitzman S, Tabenkin H, Plakht Y, Friger M, Greenfield S, Kaplan S. Patients' participation improves diabetes-related outcomes in primary care: the DIABPRICARE study [Abstract]. Presented at the European Diabetes Epidemiology Group Conference, Salerno, Italy, 24–27 April 2004. Google Scholar12. Greenfield S, Kaplan SH, Ware JE, Yano EM, Frank HJ. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448-57. [PMID: 3049968] CrossrefMedlineGoogle Scholar13. Kaplan SH, Gandek B, Greenfield S, Rogers W, Ware JE. Patient and visit characteristics related to physicians' participatory decision-making style. Results from the Medical Outcomes Study. Med Care. 1995;33:1176-87. [PMID: 7500658] CrossrefMedlineGoogle Scholar14. The Robert Wood Johnson Diabetes Care Initiative. Accessed at diabetesnpo.im.wustl.edu on 7 July 2004. Google Scholar15. Roblin D, Kaplan S, Greenfield S, Roberts M. Effects of changing collaborative clinical culture on workforce morale and patient outcomes in the primary practice of an MCO [Abstract]. Presented at the AcademyHealth Annual Research Meeting, Nashville, Tennessee, 27–29 June 2003. Google Scholar16. Diabetes Physician Recognition Program, National Committee for Quality Assurance. Accessed at www.ncqa.org/dprp on 7 July 2004. Google Scholar17. Heart/Stroke Recognition Program, National Committee for Quality Assurance. Accessed at www.ncqa.org/hsrp on 7 July 2004. Google Scholar18. Eisenberg JM. Measuring quality: are we ready to compare the quality of care among physician groups? [Editorial]. Ann Intern Med. 2002;136:153-4. [PMID: 11790069] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Sheldon Greenfield, MD; Sherrie H. Kaplan, PhD, MPHAffiliations: From University of California, Irvine, Irvine, CA 92697.Disclosures: None disclosed.Corresponding Author: Sheldon Greenfield, MD, Center for Health Policy and Research, University of California, Irvine, 111 Academy Way, Suite 220, Irvine, CA 92697.Current Author Addresses: Drs. Greenfield and Kaplan: Center for Health Policy and Research, University of California, Irvine, 111 Academy Way, Suite 220, Irvine, CA 92697. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study Eve A. Kerr , Robert B. Gerzoff , Sarah L. Krein , Joseph V. Selby , John D. Piette , J. David Curb , William H. Herman , David G. Marrero , K.M. Venkat Narayan , Monika M. Safford , Theodore Thompson , and Carol M. Mangione Metrics Cited byTraining leaders for a culture of quality and safetyDo associations between employee self-reported organizational assessments and attitudinal outcomes change over time? An analysis of four Veterans Health Administration surveys using structural equation modellingAn Overview of Evidence-Based Mental HealthReconsidering the Veterans Health Administration: A Model and a Moment for Publicly Funded Health Care DeliveryJoan J. Ryoo, MD, MSHS and Jennifer L. Malin, MD, PhDCharacteristics and Outcomes of Very Elderly Patients After First Hospitalization for Heart FailurePhysician Characteristics Associated with Early Adoption of Electronic Medical Records in Smaller Group PracticesThe Impact of Information Technology and Organizational Focus on the Visibility of Patient Care ErrorsDeclining mortality following acute myocardial infarction in the Department of Veterans Affairs Health Care SystemExtreme Makeover: Transformation of the Veterans Health Care SystemEffect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and UtilizationCKD Screening and Management in the Veterans Health Administration: The Impact of System Organization and an Innovative Electronic RecordMeasuring Practice Systems for Chronic Illness Care: Accuracy of Self-Reports from Clinical PersonnelOpting out of an integrated healthcare system: Dual-system use is associated with poorer glycemic control in veterans with diabetesIOM ReportEmployee Working Conditions and Healthcare System Performance: the Veterans Health Administration ExperienceIs the Number of Documented Diabetes Process-of-Care Indicators Associated With Cardiometabolic Risk Factor Levels, Patient Satisfaction, or Self-Rated Quality of Diabetes Care?Improving performance through knowledge translation in the Veterans Health AdministrationChronic disease and the healthcare crisisThe Quality of Preventive Medical Care for Homeless Veterans with Mental IllnessCommentary: Measuring the Quality of the VA Health Care System 17 August 2004Volume 141, Issue 4Page: 316-318KeywordsElectronic medical recordsHealth careHealth care qualityHealth care quality assessmentHealth services researchPatientsQuality improvementRenal diseasesResearch quality assessmentVeteran care ePublished: 17 August 2004 Issue Published: 17 August 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...