Quality enhancement research initiative in ischemic heart disease - A quality initiative from the Department of Veterans Affairs

Despite the dramatic fall in ischemic heart disease (IHD) mortality rates o ver the last 3 decades, it remains the number one cause of death in the Uni ted States, and one of the most frequent indications for care by the US Dep artment of Veterans Affairs. National practice guidelines have been develop ed and disseminated both by societies that specialize in cardiology and wit hin the Veterans Health Administration. Despite these efforts, a substantia l minority remains of patients with IHD who are not treated with guideline- recommended therapies. The Quality Enhancement Research Initiative in IHD i s a Veterans Health Administration-sponsored initiative to address the gap between guideline-recommended therapies and actual Department of Veterans A ffairs practice. Because guideline development for patients with IHD is rel atively mature, the Quality Enhancement Research Initiative in Ii-ID will c oncentrate on measuring existing practices, implementing interventions, and evaluating outcomes in veterans with IHD. Measurement of existing practice s will be evaluated through analyses of existing Veterans Affairs databases developed for the Continuous Improvement in Cardiac Surgery Program, as we ll as data collected at the Center for the Study of Practice Patterns in ve terans with acute myocardial infarction. To measure existing practices in o utpatients with IHD, we plan to develop a new database that extracts electr onic data from patient laboratory and pharmacy records into a relational da tabase. Interventions to address gaps between guideline recommendations and actual practice will be solicited and implemented at individual medical ce nters. We plan to emphasize point-of-care electronic reminders as well as o nline decision support as methods for improving guideline compliance.