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Classifying the Effectiveness of Veterans Affairs Guideline Implementation Approaches

Iowa City Veterans Af-fairs Medical Center, Iowa City, IA, bootsmillerb{at}lmail.medicine.uiowa.edu

Jon W. Yankey, MS

Iowa City Veterans Af-fairs Medical Center, Iowa City, IA

Stephen D. Flach, MD, PhD

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

Marcia M. Ward, PhD

Department of Health Management and Policy, The University of Iowa, Iowa City, IA

Thomas E. Vaughn, PhD

Department of Health Management and Policy, The University of Iowa, Iowa City, IA

Karl F. Welke, MD

Department of Surgery, The University of Iowa College of Medicine, Iowa City, LA

Bradley N. Doebbeling, MD, MSc

Roudebush Veterans Affairs Medical Center, Regenstrief Institute, and Indiana University School of Medicine, Indianapolis, IN

Hospitals use numerous guideline implementation approaches with varying success. Approaches have been classified as consistently, variably, or minimally effective, with multiple approaches being most effective. This project assesses the Department of Veterans Affairs (VA) use of effective guideline implementation approaches. A survey of 123 VA quality managers assessed the approaches used to implement the chronic obstructive pulmonary disease, diabetes mellitus, congestive heart failure, and major depressive disorder guidelines. Approaches were categorized based on their effectiveness, and the total number of approaches used was calculated. Commonly used approaches were clinical meetings, summaries, and revised forms. Consistently and minimally effective approaches were used most frequently. Most hospitals used 4P7 approaches. Odds ratios demonstrated that consistently effective approaches were paired with minimally and variably effective approaches. The frequent use of consistently effective approaches and multiple approaches benefits VA adherence. However, VA hospitals should consider selective combinations of approaches to ensure the use of the most effective implementation methods.

Key Words: Guideline implementation • practice guidelines • quality • United States Department of Veterans Affairs

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