# Developing Benefit-Based Performance Measurement for VHA

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

Performance measures are the specific care choices that are evaluated when judging the quality of care a
doctor provides. Guiding quality of care with performance measurement was one of the greatest successes of
the VHA transformation of the 1990s; reinvigorating performance measurement is a primary goal of today's
VHA transformation.
Current performance measures have known limitations. They do not personalize treatments' risks and benefits
to individual patients. Some do not measure particularly important care or do not allow for appropriate patient-
centered exceptions, such as for very ill patients. They create a burden for doctors. Doctors and clinical
leaders have rarely had say in helping make scores useful and understandable.
There is currently a push to summarize multiple performance measures into composite scores that measure a
clinic's overall care. The best way to accomplish this, however, is unknown. Most health organizations and
insurers use an approach that prioritizes simplicity. Medicare is developing an approach that prioritizes being
able to distinguish one clinic from another – have fewer ties. Here, we lay out a new “benefit-based” approach;
one that prioritizes the amount care can improve patient outcomes.
Prevention of cardiovascular disease (CVD) is an ideal case for testing the performance measurement issues
discussed above. It has an exceptionally strong clinical evidence base; CVD is the leading cause of morbidity
and mortality in VA, and there has already been extensive work on developing individual performance
measures. Furthermore, our work and that of others has already laid the groundwork for how care could be
better personalized, and we already have a strong ongoing partnership with the VA Center for Analytics and
Reporting.
In this project, we propose examining alternative approaches to constructing composite performance measures
for the medicines of CVD prevention, including statin, blood pressure, and anti-platelet therapies like aspirin.
Can a more personalized, benefit-based CVD performance approach improve on conventional approaches to
composite construction in reliability, validity, or usability? Is it feasible to create a composite that incorporates
more clinical nuance, is preferred by VA leadership and frontline PACT members, and can be communicated in
ways that help users improve their performance? This project focuses on CVD prevention, but the model being
explored could be generalized to other conditions.
In Aim 1, we will develop composite performance measures for cardiovascular disease prevention using three
different techniques, including our new benefit-based approach. We will also explore the impact of different
exclusions or improving data quality on performance measurement.
In Aim 2, we will test and compare these new composite measures for reliability, validity, and their potential
impact.
In Aim 3, we will test the measures' acceptability and utility with clinicians and clinical and national l...

## Key facts

- **NIH application ID:** 9852297
- **Project number:** 5I01HX002014-04
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Jeremy Broder Sussman
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-01-01 → 2020-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9852297

## Citation

> US National Institutes of Health, RePORTER application 9852297, Developing Benefit-Based Performance Measurement for VHA (5I01HX002014-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9852297. Licensed CC0.

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