# Assessing Episode-Based Surgical Quality in VA and Community Care Settings

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: Since initiation of the National Surgical Quality Improvement Program nearly 30 years ago, VA
has been at the forefront of surgical quality measurement and improvement. Much of this work has been
focused on assessing risk-adjusted postoperative complications, with less attention paid to important care
processes, and even less attention to evaluating and improving quality across the full continuum of surgical
care, including the presurgical period. The importance of adapting current and new measures to reliably and
accurately assess the full continuum of surgical care will increase as greater numbers of Veterans use VA-
purchased Community Care (CC). While one out of three VA patients receive CC, quality assessment is far
less developed for CC than for those receiving care within the VA.
Significance: With the focus of quality assessment being on postoperative outcomes and complications,
quality of care across the entire surgical continuum is largely ignored, especially issues of timeliness, overuse,
and underuse in the presurgical period. Defined episodes of care, which constitute a set of services provided to
treat a clinical condition, have been promoted to assess quality, coordination, and cost among providers
involved in a patient’s care. Although episode models have not been used by VA to monitor quality, VA has the
opportunity to use a surgical episode framework to measure surgical quality more broadly, understand the
value of this approach, and inform future quality reporting needs for VA-delivered and VA-purchased CC. The
importance of examining surgical episode quality is even more salient given the rapid increase in VA-
purchased CC, with an inevitable need to ensure that quality is maintained across all settings.
Innovation and Impact: The goal of this proposal is to develop an innovative model to measure condition-
specific surgical episode quality, including pre-, peri-, and postoperative care phases, for 3 common
procedures of varying complexity. This work will advance the science of quality measurement through
assessment across the entire surgical continuum. In applying this model to existing VA and CC data, we will
identify new opportunities for surgical quality improvement in VA medical centers and will facilitate a condition-
specific comparison of episode quality differences between VA and CC settings. We will also identify limitations
in episode quality assessment for CC relative to VA using existing CC data sources.
Specific Aims: Aim 1: Define condition-specific quality measures for surgical episode quality evaluation. Aim
2: Measure the performance gap and reliability of episode-based quality measures across VA medical centers.
Aim 3: Assess the feasibility of applying episode-based quality measurement in the CC setting.
Methodology: Aim 1: We will identify new quality measures in response to identified episode measurement
gaps. A Delphi panel will rate the newly proposed quality measures for face validity, impo...

## Key facts

- **NIH application ID:** 10830908
- **Project number:** 5I01HX003557-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Erika D Sears
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-04-01 → 2027-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10830908

## Citation

> US National Institutes of Health, RePORTER application 10830908, Assessing Episode-Based Surgical Quality in VA and Community Care Settings (5I01HX003557-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10830908. Licensed CC0.

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