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What Factors Influence Provider Knowledge of a Congestive Heart Failure Guideline in a National Health Care System?

Division of Cardiothoracic Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa

Bonnie J. Boots Miller, PhD

Program in Health Services Research, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa

Kimberly D. McCoy, MD

Program in Health Services Research, Iowa City Veterans Affairs Medical Center and the Department of Internal Medicine, The University of Iowa College of Medicine, Iowa City, Iowa

Thomas E. Vaughn, PhD

The University of Iowa College of Nursing, Iowa City, Iowa

Marcia M. Ward, PhD

Department of Health Management and Policy, The University of Iowa College of Public Health, Iowa City, Iowa

Stephen D. Flach, MD, PhD

Program in Health Services Research, Iowa City Veterans Affairs Medical Center, the Department of Internal Medicine, The University of Iowa College of Medicine, and The University of Iowa Public Policy Center, Iowa City, Iowa

Paul M. Peloso, MD, MSc

Department of Internal Medicine, The University of Iowa College of Medicine, Iowa City, Iowa

Bernard A. Sorofman, PhD

University of Iowa College of Pharmacy, Iowa City, Iowa

Toni Tripp-Reimer, PhD

The University of Iowa College of Nursing, Iowa City, Iowa

Bradley N. Doebbeling, MD, MSc

Department of Internal Medicine, SE 625 GH, The University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242 brad-doebbeling{at}uiowa.edu

Provider knowledge is a potential barrier to adherence to clinical guidelines. The purpose of this study is to assess the impact of organizational, provider, and guideline factors on provider knowledge of a congestive heart failure (CHF) clinical practice guideline (CPG) in the Veterans Health Administration (VHA) health care system. We developed a survey to investigate institution-level factors influencing the effectiveness of guideline implementation, including characteristics of the guideline, providers, hospital culture and structure, and regional network. Survey participants were quality managers, primary care administrators, and other individuals involved in primary care CPG implementation at 143 VHA hospitals with ambulatory care clinics. Potential explanatory variables were grouped into 11 factors. Multivariate regression models assessed the association between these factors and reported levels of provider knowledge regarding the CHF guideline at the hospital level. Two hundred forty surveys from 126 of 143 (88%) VHA hospitals were returned. Provider knowledge of the CHF guideline was estimated as "great" or "very great" by 58% of respondents. Three predictor factors (dissemination approaches, use of technology in guideline implementation, and hospital culture) were independently associated (P c .05) with provider knowledge. Specific variables within these categories that were related to greater knowledge included physician belief that guidelines were applicable to their practice, distribution of guideline summaries, use of guideline storyboards in clinic areas, the use of technology (eg, electronic patient records) in CPG implementation, and establishment of implementation checkpoints and deadlines. Provider knowledge of guidelines is affected by factors at various organizational levels: dissemination approaches, use of technology, and hospital culture. Guideline implementation efforts that target multiple organizational levels may increase provider knowledge.

Key Words: Ambulatory care • attitudes • congestive heart failure • hospitals • knowledge • practice • practice guidelines • US Department of Veterans Affairs

American Journal of Medical Quality, Vol. 18, No. 3, 122-127 (2003)
DOI: 10.1177/106286060301800306


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