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American Journal of Medical Quality
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Early Adoption of Human Immunodeficiency Virus Quality Improvement in Veterans Affairs Medical Centers: Use of Organizational Surveys to Measure Readiness to Change and Adapt Interventions to Local Priorities

Henry D. Anaya, PhD

VA Greater Los Angeles HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, henry.anaya{at}med.va.gov

Elizabeth M. Yano, PhD

VA Greater Los Angeles HSR&D Center of Excellence for the Study of Healthcare Provider Behavior and UCLA School of Public Health

Steven M. Asch, MD, MPH

Greater Los Angeles HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, and David Geffen School of Medicine, UCLA

Potential delivery system responsiveness to quality improvement (QI) interventions is rarely assessed before implementation, although it might aid in interventional design. Preparing for a national initiative, we assessed Veterans Affairs (VA) human immunodeficiency virus (HIV) clinic organizational characteristics and attitudes toward QI interventions. Current QI activities and attitudes toward potential effectiveness of several techniques to improve antiretroviral and opportunistic infection prophylaxis therapy were assessed. These included computerized clinical reminders (CRs), group-based QI, expert advice, and facility and provider-level audit/feedback. Organizational characteristics were also examined. Respondents rated CRs and group-based QI (GBQI) interventions most highly. Western and complex facilities viewed CR and GBQI interventions more positively than less complex facilities or those in other regions, even controlling for organizational characteristics and perceived barriers to change. VA clinicians favored CR and GBQI over facility/provider feedback. The persistence of regional variation should be further explored. Organizational surveys of attitudes toward potential QI interventions can assist in choosing interventions and targeting specific facilities.

Key Words: Clinical reminders • group-based quality improvement • organizations • preinterventional surveys • provider attitudes • Veterans Administration

American Journal of Medical Quality, Vol. 19, No. 4, 137-144 (2004)
DOI: 10.1177/106286060401900402
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[Abstract] [Full Text] [PDF]


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