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American Journal of Medical Quality, Vol. 22, No. 6, 438-444 (2007)
DOI: 10.1177/1062860607304928

Self-Reported Performance Improvement Strategies of Highly Successful Veterans Health Administration Facilities

Thomas J. Craig, MD, MPH

Department of Veterans Affairs, Office of Quality and Performance, Washington, DC, tlc1963{at}earthlink.net

Jonathan B. Perlin, MD, PhD, MSHA

HCA Healthcare, Inc., Nashville, Tennessee

Barbara B. Fleming, MD, PhD

Department of Veterans Affairs, Office of Quality and Performance, Washington, DC

The Veterans Health Administration (VHA) has achieved considerable success in improving health care through the use of clinical performance measures. This report examines the self-reported strategies used by the most successful facilities in the VHA system. For fiscal year 2002, facilities that scored the highest on any of 24 clinical performance measures were queried as to which strategies they used to achieve their level of performance. The most commonly cited strategies across all performance categories were organizational change (55.6%), clinical reminders (41.4%), audit and feedback to providers (39.6%), and staff education (32.5%). Certain strategies were more likely to be cited for 1 or more specific performance categories (eg, clinical reminders for immunization [61.1%], screening [60.6%]). These findings suggest that successful facilities are generally using evidence-based strategies to achieve high clinical performance. However, some evidence-based implementation strategies were rarely cited (eg, use of clinical champions). (Am J Med Qual 2007;22: 438-444)

Key Words: performance improvement • quality measures • implementation strategies

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