Monitoring Outcomes and Defining Success
A thoughtfully organized VA-MDC has the potential to lead to improvement
in many areas, including patient clinical outcomes, quality of life,
institutional finances, research advancement, and career development.
Financial viability is key to garnering institutional leadership
support. A system to track patient referrals to the clinic, the outcomes
of those visits (including labs, imaging, and surgical procedures
ordered), and the revenue generated by the clinic is key to supporting
the growth of a program. This information is necessary to support the
time and effort needed from various clinical providers. Depending on the
size of the center, there are several options for tracking information
to support financial viability. Centers may consider use of a unique
department code, maintaining a running list of ICD-10 and CPT codes to
track within the VA-MDC (or within individual provider clinics),
monitoring referral numbers, and maintaining a patient list within the
electronic health record. Each of our programs has utilized the
assistance of department administrators to track financial information.
A process for tracking patient clinical outcomes is key to continuous
quality improvement, as well as providing organization for involvement
in clinical research. Incorporating outcomes and quality improvement
measures is beneficial for patients in the VA-MDC as well as providing
an opportunity for academic rigor. The use of a uniform electronic
health record for patients seen in the VA-MDC, as well as the clinical
and/or research database, will assist in accurate measurements of
outcomes and quality. During the development phase of the VA-MDC, we
recommend creating a form or flowsheet with discrete data fields for
collection and a single progress note template to be used by all VA-MDC
providers. At both of our programs, we have also incorporated quality of
life tools into the patient intake and monitoring process. Each patient
and parent completes the questionnaire at regular intervals. Having
these measurement tools built into the EHR allows for prospective data
collection and more rapid data analysis than is allowed with manual data
abstraction. This research infrastructure also includes monitoring
funding sources, tracking how funding is utilized, grant submissions,
QOL and formal research projects, publication success, and member career
development. An enormous benefit of the VA-MDC is the ability for
research collaboration amongst a diverse group of healthcare
professionals with varied expertise and experience. Teams can utilize
this structure to develop a robust research collaboration, but should be
mindful of the different academic and professional needs of each team
member.