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.