VA Primary Care Leaders Assess Novel Efficiency Measure

Existing productivity measures often count services or clinician activity without incorporating team input and multiple care outcomes. ITEM uses data envelopment analysis to compare staff time invested with four practice outputs: access, clinical quality, patient care experiences and number of patients served, while accounting for patient population complexity. In this qualitative evaluation, 34 interprofessional participants from nine geographically dispersed VA medical centers and affiliated community-based outpatient clinics reviewed visualizations comparing practice scores with national VA averages. Researchers used semi-structured interviews and focus groups to assess perceived validity and usefulness.

Participants generally viewed ITEM as having face, construct and content validity, and saw the measure and its visual displays as potentially useful for efficiency-improvement efforts. They identified limitations, including no measures of team functioning or burnout, time lags when team composition or outputs change, and possible alternative output measures or additional local-context data.

The findings support further development, not established effectiveness in improving care. The study assessed user perceptions in a convenience sample within the VA system; it did not test whether using ITEM improves efficiency or patient outcomes. The authors report that ITEM had previously been calculated across 703 VA community-based primary care practices, but this study focused on qualitative feedback.