Clients

Overview

Quality review of medical care in the United States no longer operates within a model dealing with individual cases that do not conform to care standards. The new model now measures the performance of health care systems and identifies processes and outcomes that can be systematically improved. At the same time, the U.S. Department of Defense quality management approach shifted to a similar model with the creation of the National Quality Management Program. The NQMP focuses on the areas of credentials, privileges, accreditation, malpractice, adverse events, National and Defense Practitioner Data Banks, Health Care integrity and Protection Data Bank, medical readiness, and external peer review of care.

Objectives

The goal of the NQMP ERC effort is to directly affect and ultimately improve the quality of care provided to Military Health System (MHS) beneficiaries. The scope of the NQMP has successfully evolved as the program matures and realizes real and measurable improvements in the quality of MHS health care.

Requirements

• Participation in External Organization Quality Measurement Processes: JCAHO ORYX®
• Perform External Comparisons of MHS Outcomes With Civilian Benchmarks
• Perform Internal Comparisons Between MTFs
• Facilitate Quality Improvement Efforts at the MTF level

Solution Description

In this project, VMD works as a subcontractor to Lockheed Martin, who is responsible for the External Review of Care (ERC) function for the DoD National Quality Management Program, implemented the NQMP web site.

• Special studies and performance measures
• Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) ORYX measurement and reporting to JCAHO for accreditation
• Education and performance improvement
• NQMP linkage to DoD/Department of Veterans Affairs (VA) Clinical Best Practice Guidelines and Metrics Development

The focus of NQMP is the evaluation of outcomes as a principal measure of quality and the relationship of outcomes to cost. Intra-organizationally, this program allows DoD to compare their corporate outcomes by Medical Treatment Facility (MTF), by Region, or by the enterprise level. This allows for the formulation of outcomes and identification of best clinical practice by facility creating a Continuous Quality Improvement (CQI) culture in each facility based on clinical evidence through an ERC. As a quality program, NQMP is vital to the MHS because it creates a uniform standard of clinical care and outcomes for DoD and allows easy comparison across Services and MTFs. It also provides the mechanism for reporting attainment of clinical outcome metrics to the JCAHO. The NQMP has targeted its special studies toward the DoD's high-volume, high-risk, and high-cost conditions such as preventive medicine, cardiovascular disease, diabetes, asthma, and mental health.

The VMD/Lockheed Martin team uses its extensive experience with transferring knowledge into practice to continue to create and administer training programs that provide a diversified educational structure in support of the NQMP. This educational component encompasses the administration of online distance learning initiatives offering continuing educational credits (CEUs) to participants through a partnership with the Uniformed Services University of the Health Sciences (USUHS). Ten computer-based, interactive online activities were developed and implemented over the past year and 16 online activities will be developed based on the published special studies in coming years. In addition to the online educational activities that focus on special studies, the VMD/Lockheed Martin team will develop two supplemental online continuing education activities to cover the use of evidence-based practice and methods to translate Clinical Practice Guidelines (CPGs) into practice.

Many aspects of the NQMP are posted on the NQMP Web site: http://www.nqmp.info. This Web site was developed and implemented by VMD/Lockheed Martin to include user login to secure areas and online educational activities.

Process

Lockheed Martin team developed a Performance Improvement Plan (PIP) to provide the framework for incorporating the redesigned ERC function into the most current thinking and recommendations on performance improvement (PI). The PIP allows PI to be incorporated into an already accepted MHS reengineering process, Population Health Improvement (PHI). The PHI policy and guide includes chapters on managing conditions and diseases using evidence-based medicine, based on the DoD/VA Clinical Practice Guideline effort, and measuring outcomes. The PIP lays the groundwork to align a number of PI efforts under a single coordinated and sustainable effort.

The VMD/Lockheed Martin team uses its management skill and resources as well as its clinical and technical knowledge to analyze and interpret information needed by the MHS to optimize delivery of health care.

Results

VMD/Lockheed Martin has been responsible for the NQMP ERC function since January 2001. Under VMD/Lockheed Martin, the scope of the NQMP has successfully evolved and continues to achieve real and measurable improvements in the quality of health care provided to MHS beneficiaries. After successfully winning the re-competed NQMP contract with the TMA, the VMD/Lockheed Martin team has continually performed above the expectation of our client as indicated by their positive feedback.