title: A national clinical quality program for Veterans Affairs catheterization laboratories (from the Veterans Affairs clinical assessment, reporting, and tracking program).
abstract: A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts. Integrated within the VA electronic health record, the CART program uses a specialized software platform to collect real-time patient and procedural data for all VA patients undergoing coronary procedures in VA catheterization laboratories. The program began in 2005 and currently contains data on 434,967 catheterization laboratory procedures, including 272,097 coronary angiograms and 86,481 percutaneous coronary interventions, performed by 801 clinicians on 246,967 patients. We present the initial data from the CART program and describe 3 quality-monitoring programs that use its unique characteristics-procedural and complications feedback to individual labs, coronary device surveillance, and major adverse event peer review. The VA CART program is a novel approach to electronic health record design that supports clinical care, quality, and safety in VA catheterization laboratories. Its approach holds promise in achieving the goals of a learning health care system.
authors.affiliation: Cardiology Section (111B), Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: thomas.maddox@va.gov.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: Cardiology Section (111B), Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Plomondon
authors.affiliation: Cardiology Section (111B), Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Megan
authors.initials: M
authors.lastname: Petrich
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.affiliation: Cardiology Section (111B), Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Hans
authors.initials: H
authors.lastname: Gethoffer
authors.affiliation: Cardiology Section (111B), Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Gregory
authors.initials: G
authors.lastname: Noonan
authors.affiliation: Veterans Affairs Office of Analytics and Business Intelligence, Seattle, Washington.
authors.forename: Brian
authors.initials: B
authors.lastname: Gillespie
authors.affiliation: Cardiology Section (111B), Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Tamara
authors.initials: T
authors.lastname: Box
authors.affiliation: Veterans Affairs Office of Analytics and Business Intelligence, Seattle, Washington.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Fihn
authors.affiliation: Veterans Affairs Central Office, Washington, DC.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Jesse
authors.affiliation: Cardiology Section (111B), Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
mesh_terms: D000368:Aged; D002300:Cardiac Care Facilities / Q000592:standards*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D003625:Data Collection / Q000379:methods; D057286:Electronic Health Records; D005260:Female; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D012107:Research Design; D012189:Retrospective Studies; D012984:Software; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health / Q000592:standards*