Identifying Barriers in Meeting the 2-Day Post Discharge Telephone Call: A National Veteran's Hospital Performance Measure

In order to improve the quality of health care to the nation's veterans, the Veteran's Health Administration (VHA) adopted a patient-centered medical home model in 2011. They refer to it as the Patient Aligned Care Team (PACT). As part of this transition many new performance measures were introduced in order to track compliance with key care indicators. One of these performance measure is the 2-day post discharge telephone call. Many clinics in the area are not meeting the performance measure minimum of 45% and only a very few who are meeting the benchmark of 75%. The overall compliance to this performance measure is one of the lowest in the country. Research has shown that communication with a primary care provider greatly reduces the risk of hospital readmission. This is becoming increasingly important in a fiscally responsible healthcare climate. Hospital readmissions are estimated to cost as much as 44 billion dollars per year. Medicare has begun penalizing hospitals that have high readmission rates. The objectives for this project were to, (1) identify the PACT teams that are not meeting the national VHA 2-day post discharge performance measure, (2) apply the FADE QI model in addressing the identified barriers, and (3) present the findings to key stake holders within the VHA system. In order to identify the PACT teams that were not meeting the performance measures clinic data reports were reviewed. The supervisors of the clinics were questioned to ascertain any known barrier such as staffing or personnel issues. Once this information was collected a questionnaire was sent to the staff to discover what they perceived as barriers to meeting the 2-day post discharge telephone call performance measure. The next step was to interview those who did not participate in the questionnaire in their office to discuss the barriers identified and possibly uncover additional barriers. This was also an educational opportunity to explain the benefit of the 2-day post discharge telephone call performance measure. The information collected from these interview and the questionnaires were presented to key stake holders within the local VHA system. In summary this project identified clinics that are not at goal for meeting the 2-day post-discharge call national VHA performance measure. PACT teams who were contributing to the low percentage points were invited to participate in questionnaires and interviews to discover the reasons the performance measure were not being made. The information identified was provided to management and key stakeholders within the VHA in order that they may be able to remove the barriers.