Strategic Goal: Honor and serve veterans in life and memorialize them in death for their sacrifices on behalf of the Nation. Veterans will have dignity in their lives, especially in time of need, through the provision of health care, pension programs and life insurance, and the Nation will memorialize them in death for the sacrifices they have made for their country.

Objective: Improve the overall health of enrolled veterans including special populations of veterans through high quality, safe, and reliable health services.

Performance Goal: Increase the scores on the Chronic Disease Care Index (CDCI) to 95 percent and the Prevention Index (PI) to 90 percent.

VA ensures the consistent delivery of health care by implementing standard measures based upon the provision of evidence-based care by focusing on chronic diseases, prevention, and use of clinical guidelines. Clinical guidelines are recommendations for the performance or exclusion of specific procedures or services derived through rigorous methodological approaches such as determination of appropriate criteria and literature reviews to determine strength of evidence in relation to these criteria.

The chronic disease care index (CDCI) measures how well VA follows nationally recognized clinical guidelines for ischemic heart disease, hypertension, chronic obstructive pulmonary disease, diabetes mellitus, and obesity. Investment in effective chronic disease management results in improved health of veterans and reduced use of services. Since a large percentage of veterans seek care for one or more chronic diseases, improved management of chronic disease results in reductions in inpatient costs, admissions, and lengths of stay. The prevention index (PI) assesses how well VA follows nationally recognized primary prevention and early detection recommendations related to diseases with major social consequences. The diseases are: influenza and pneumococcal diseases; tobacco consumption; alcohol abuse; and cancer of the breast, cervix, colon, and prostate. Effective disease and injury prevention is an effective tool for improving veterans’ health. Although underutilized by the health care industry, disease and injury prevention is an effective tool used by VA to improve veterans’ health.

In conjunction with DoD, VA develops and implements clinical practice guidelines with a long-range view toward ensuring continuity of care and a seamless transition for a patient moving from one system to the other.

There are no major management challenges that will affect achievement of this performance goal.

The External Peer Review Program (EPRP), a contracted, on-site review of clinical records, is the source for the CDCI and PI. The EPRP serves as a functional component of VHA’s quality management program. The contractor evaluates the validity and reliability of the data using accepted statistical methods. Ongoing inter-rater reliability assessments are performed quarterly for each abstractor in the review process. A random sampling protocol is used to select individual patient charts. Abstractors then review the charts to determine if appropriate data are included. The ensuing data are aggregated into appropriate indices. A quarterly report is produced for each VISN.

The source for the CDCI and the PI is on-site review of the clinical record. The measures for the goal will be the application of a random sampling protocol that looks at individual patient charts, abstracts the appropriate data, and calculates the indices. A VISN-specific report is produced quarterly. Beginning with the FY 2000 cycle, counseling on tobacco use will be removed from the CDCI and placed with the clinical guideline for tobacco use. This will bring clinical practice in line with the new guideline calling for counseling two times per year.

(For additional information on this performance goal, refer to Medical Programs, Volume 2, Chapter 2.)