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Editorials

Improving Quality

Lessons From the Department of Veterans Affairs

Stephan D. Fihn, MD, MPH

From the Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, and the Department Medicine and Health Services, Division of General Internal Medicine, University of Washington, Seattle, Wash.

Correspondence to Stephan D. Fihn, MD, MPH, Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101. E-mail stephan.fihn@va.gov

Key Words: Editorials • hypertension

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In 1967, the first multicenter randomized controlled trial of treatment for hypertension was published by the newly created Veterans Administration Cooperative Studies Program, demonstrating the remarkable effectiveness of drug treatment for what would now be considered severe hypertension (average diastolic pressure 115 to 129 mm Hg).¹ During the ensuing 4 decades, there have been remarkable strides made to improve care for this very common condition, including development of effective new drugs and acceptance of lower blood pressure thresholds and targets. It is more than fitting that the Department of Veterans Affairs (VA) should remain a leading contributor to these efforts.

Article see p 392

Despite these advances, however, efforts to improve awareness of high blood pressure and achievement of treatment goals remains suboptimal from a national perspective, particularly among blacks and other ethnic minorities.² Increasingly it is being acknowledged that additional progress depends far more on improving systems of care than further advances in pharmacology. Because they are frequently characterized by defined populations, substantial administrative resources, infrastructure such as information systems, an emphasis on primary care, and coordinated benefits, large integrated health systems have been most successful in implementing improvements of care for chronic conditions. In this issue of Circulation: Cardiovascular Quality and Outcomes, Choma et al³ describe the results of efforts to improve the quality of monitoring and treatment of hypertension in 1 of the 21 regional networks (Veterans Integrated Service Networks [VISNs]) that comprise the VA health care system.

To be appreciated, the results reported by Choma . . . [Full Text of this Article]

Related Article

Quality Improvement Initiatives Improve Hypertension Care Among Veterans

Neesha N. Choma, Robert L. Huang, Robert S. Dittus, Kathy E. Burnham, and Christianne L. Roumie
Circ Cardiovasc Qual Outcomes 2009 2: 392-398. [Abstract] [Full Text] [PDF]