A national clinical quality program for Veterans Affairs catheterization laboratories (from the Veterans Affairs clinical assessment, reporting, and tracking program).

A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts.

Feasibility of proactive medical device surveillance: the VA Clinical Assessment Reporting and Tracking (CART) program.

Background: Timely identification and reporting of medical device problems is critical to postmarket device surveillance programs to maximize patient safety. Cardiac catheterization laboratories are high-device utilization areas well suited for device surveillance.

Objective: To demonstrate the feasibility of the national VA Clinical Assessment, Reporting, and Tracking (CART) system, embedded in the electronic health record of all 76 VA cardiac catheterization laboratories, to document unexpected problems with medical devices at the point of care.

Reducing major vascular events among VA primary care patients: an extraordinary opportunity.

Data from randomized trials document that the frequency of major vascular events can be significantly reduced by lowering serum cholesterol and systolic blood pressure in high-risk patients. The recent publication of the Heart Protection Study (HPS) provided randomized trial evidence to support the recommendation of the National Cholesterol Education Program Adult Treatment Panel III to broaden statin use to include patients whose risk for a coronary event is equivalent to that among patients with manifest coronary artery disease, such as those with diabetes or cerebral, aortic, or peripheral vascular disease. Similarly, recent meta-analyses of hypertension trials provide us precise estimates of the benefits of lowering blood pressure.