PubMed · 4369368
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S Schuler, L B Campbell. The theme is change.. https://pubmed.ncbi.nlm.nih.gov/4369368/
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The Department of Veterans Affairs (VA) Health Care System is the largest integrated single-payer system in the United States. Its primary mission is to provide primary care, specialized care, and related medical and social support services to veterans. Much time and resources are expended on chronic obstructive pulmonary disease, known as COPD, at VA hospitals and clinics, thereby justifying the development of multifaceted strategies to address this problem. This article discusses the special problems of COPD in veterans who use VA facilities. The article also highlights the contributions of the VA to the research, training, and development of clinical practice guidelines for the management of this pervasive disease and presents the challenges that threaten its role in this area.
The authors describe use of aggregate root cause analysis, which provides a systematic process for analyzing high-priority, frequent events.