Background
Methods
Overview
No. | Strategy | Sites N (%) | Correlation |
P value |
---|---|---|---|---|
In FY15 did your center use any of these infrastructure changes to promote HCV care in your center?
| ||||
1
|
Change physical structure and equipment (e.g., purchase a FibroScan, expand clinic space, open new clinics)
|
42 (53)
|
0.36
|
<0.01
|
2 | Change the record systems (e.g., locally create new or update to national clinical reminder in CPRS, develop standardized note templates) | 57 (71) | −0.02 | 0.89 |
3
|
Change the location of clinical service sites (e.g., extend HCV care to the CBOCs)
|
21 (26)
|
0.36
|
<0.01
|
4 | Develop a separate organization or group responsible for disseminating HCV care (outside of the HIT Collaborative) | 18 (23)
| 0.21 | 0.07 |
5 | Mandate changes to HCV care (e.g., when you changed to the new HCV medications was this based on a leadership mandate?) | 44 (55) | 0.05 | 0.69 |
6 | Create or change credentialing and/or licensure standards (e.g., change scopes of practice or service agreements) | 23 (29) | 0.01 | 0.92 |
7
|
Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation
|
3 (4)
|
0.23
|
0.04
|
8
|
Change accreditation or membership requirements
|
3 (4)
|
0.23
|
0.04
|
In FY15 did your center use any of these financial strategies to promote HCV care in your center?
| ||||
9 | Access new funding (This DOES NOT include funding from national VA for the medications, but should include receiving funds from the HIT Collaborative to your center) | 24 (30)
| 0.20 | 0.08 |
10 | Alter incentive/allowance structures | 4 (5)
| 0.04 | 0.76 |
11 | Provide financial disincentives for failure to implement or use the clinical innovations | 0 | . | . |
12 | Respond to proposals to deliver HCV care (e.g., submit a HIT proposal to obtain money for your center specifically) | 35 (44)
| 0.19 | 0.11 |
13 | Change billing (e.g., create new clinic codes for billing for HCV treatment or HCV education) | 9 (11)
| 0.17 | 0.15 |
14 | Place HCV medications on the formulary | 56 (70)
| −0.05 | 0.67 |
15 | Alter patient fees | 0 | ||
16 | Use capitated payments | 0 | ||
17 | Use other payment schemes | 4 (5)
| 0.22 | 0.06 |
18
|
Create new clinical teams (e.g., interdisciplinary clinical working groups)
|
37 (46)
|
0.25
|
0.04
|
19 | Facilitate the relay of clinical data to providers (e.g., provide outcome data to providers) | 45 (56)
| 0.20 | 0.09 |
20
|
Revise professional roles (e.g., allow the pharmacist to see and treat patients in the clinic)
|
57 (71)
|
0.24
|
0.04
|
21 | Develop reminder systems for clinicians (e.g., use CPRS reminders) | 27 (34)
| −0.16 | 0.19 |
22
|
Develop resource sharing agreements (e.g., partner with the VERC, the HITs, or other organizations with the resources to help implement changes)
|
21 (26)
|
0.24
|
0.04
|
In FY15 did your center employ any of these activities to provide interactive assistance to promote HCV care in your center?
| ||||
23 | Use outside assistance often called “facilitation” (e.g., coaching, education, and/or feedback from the facilitator) | 6 (8)
| 0.16 | 0.17 |
24
|
Have someone from inside the clinic or center (often called “local technical assistance”) tasked with assisting the clinic
|
12 (15)
|
0.38
|
<0.01
|
25
|
Provide clinical supervision (e.g., train providers)
|
35 (44)
|
0.29
|
0.01
|
26
|
Use a centralized system (i.e., from the VISN) to deliver facilitation
|
22 (28)
|
0.38
|
<0.01
|
In FY15 did your center employ any of these activities to tailor HCV care in your center?
| ||||
27 | Use data experts to manage HCV data (e.g., use the VERC, pharmacy benefits management, VISN, or CCR data experts to track patients or promote care) | 46 (58)
| 0.18 | 0.12 |
28 | Use data warehousing techniques (e.g., dashboard, clinical case registry, CDW) | 68 (85)
| 0.15 | 0.19 |
29 | Tailor strategies to deliver HCV care (i.e., alter HCV care to address barriers to care that you identified in your population using data you collected) | 50 (63)
| 0.21 | 0.08 |
30 | Promote adaptability (i.e., Identify the ways HCV care can be tailored to meet local needs and clarify which elements of care must be maintained to preserve fidelity) | 44 (55)
| 0.16 | 0.17 |
In FY15 did your center employ any of these activities to train or educate providers to promote HCV care in your center?
| ||||
31
|
Conduct educational meetings
|
41 (51)
|
0.24
|
0.05
|
32
|
Have an expert in HCV care meet with providers to educate them
|
33 (41)
|
0.34
|
<0.01
|
33
|
Provide ongoing HCV training
|
39 (49)
|
0.26
|
0.03
|
34
|
Facilitate the formation of groups of providers and fostered a collaborative learning environment
|
35 (44)
|
0.38
|
<0.01
|
35 | Developed formal educational materials | 31 (39)
| 0.00 | 0.97 |
36 | Distribute educational materials (e.g., guidelines, manuals, or toolkits) | 44 (55)
| 0.11 | 0.35 |
37 | Provide ongoing consultation with one or more HCV treatment experts | 46 (58)
| 0.11 | 0.37 |
38 | Train designated clinicians to train others (e.g., primary care providers, SCAN-ECHO) | 16 (20)
| −0.07 | 0.56 |
39
|
Vary the information delivery methods to cater to different learning styles when presenting new information
|
29 (36)
|
0.29
|
0.02
|
40 | Give providers opportunities to shadow other experts in HCV | 26 (33)
| 0.12 | 0.32 |
41 | Use educational institutions to train clinicians | 9 (11)
| 0.21 | 0.07 |
In FY15 did your center employ any of these activities to develop stakeholder interrelationships to promote HCV care in your center?
| ||||
42
|
Build a local coalition/team to address challenges
|
42 (53)
|
0.27
|
0.03
|
43
|
Conduct local consensus discussions (i.e., determine how to change things by having meetings with local leaders and providers)
|
38 (48)
|
0.42
|
<0.01
|
44 | Obtain formal written commitments from key partners that state what they will do to implement HCV care (e.g., written agreements with CBOCS) | 3 (4)
| 0.20 | 0.09 |
45
|
Recruit, designate, and/or train leaders
|
21 (26)
|
0.29
|
0.01
|
46
|
Inform local opinion leaders about advances in HCV care
|
39 (49)
|
0.33
|
<0.01
|
47
|
Share the knowledge gained from quality improvement efforts with other sites outside your medical center
|
30 (38)
|
0.32
|
<0.01
|
48
|
Identify and prepare champions (i.e., select key individuals who will dedicate themselves to promoting HCV care)
|
40 (50)
|
0.29
|
0.01
|
49 | Organize support teams of clinicians who are caring for patients with HCV and given them time to share the lessons learned and support one another’s learning | 21 (26) | 0.16 | 0.18 |
50 | Use advisory boards and interdisciplinary workgroups to provide input into HCV policies and elicit recommendations | 21 (26) | 0.09 | 0.46 |
51 | Seek the guidance of experts in implementation | 35 (44) | −0.01 | 0.92 |
52
|
Build on existing high-quality working relationships and networks to promote information sharing and problem solving related to implementing HCV care
|
49 (61) |
0.24
|
0.04
|
53
|
Use modeling or simulated change
|
10 (13) |
0.25
|
0.04
|
54
|
Partner with a university to share ideas
|
11 (14)
|
0.27
|
0.02
|
55
|
Make efforts to identify early adopters to learn from their experiences
|
13 (16)
|
0.32
|
<0.01
|
56
|
Visit other sites outside your medical center to try to learn from their experiences
|
12 (15)
|
0.30
|
0.01
|
57 | Develop an implementation glossary | 2 (3)
| 0.17 | 0.15 |
58 | Involve executive boards | 18 (23)
| 0.15 | 0.21 |
In FY15 did your center employ any of these evaluative and iterative strategies to promote HCV care in your center?
|
2 (3)
| |||
59 | Assess for readiness and identify barriers and facilitators to change (e.g., administer the organizational readiness to change survey) | 21 (26)
| 0.16 | 0.20 |
60 | Conduct a local needs assessment (i.e., collect data to determine how best to change things) | 36 (45)
| 0.12 | 0.31 |
61 | Develop a formal implementation blueprint (i.e., make a written plan of goals and strategies) | 27 (34)
| 0.11 | 0.37 |
62 | Start with small pilot studies and then scale them up | 18 (23)
| 0.08 | 0.50 |
63
|
Collect and summarize clinical performance data and give it to clinicians and administrators to implement changes in a cyclical fashion using small tests of change before making system-wide changes
|
17 (21)
|
0.25
|
0.04
|
64 | Conduct small tests of change, measured outcomes, and then refined these tests | 15 (19)
| 0.11 | 0.36 |
65 | Develop and use tools for quality monitoring (this includes standards, protocols and measures to monitor quality) | 33 (41)
| 0.07 | 0.56 |
66 | Develop and organize systems that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement (i.e., create an overall system for monitoring quality--not just tools to use in quality monitoring, which is addressed in the last item) | 24 (30)
| 0.18 | 0.14 |
67 | Intentionally examine the efforts to promote HCV care | 49 (61)
| 0.08 | 0.49 |
68 | Develop strategies to obtain and use patient and family feedback | 16 (20)
| −0.11 | 0.35 |
In FY15 did your center employ any of these strategies to engage patient consumers to promote HCV care in your center?
| ||||
69 | Involve patients/consumers and family members | 40 (50)
| 0.01 | 0.91 |
70
|
Engage in efforts to prepare patients to be active participants in HCV care (e.g., conduct education sessions to teach patients about what questions to ask about HCV treatment)
|
50 (63)
|
0.39
|
<0.01
|
71 | Intervene with patients/consumers to promote uptake and adherence to HCV treatment | 57 (71) | 0.08 | 0.51 |
72 | Use mass media (e.g., local public service announcements; magazines like VANGUARD, newsletters, online/social media outlets) to reach large numbers of people | 14 (18) | 0.00 | 0.98 |
73 | Promote demand for HCV care among patients through any other means | 32 (40) | 0.19 | 0.12 |
Participation sites and recruitment
Measures and data collection
Data analysis
Results
Characteristic | N (sites) | Percentage |
---|---|---|
Years in VA | ||
<3 | 13 | 16 |
4 to 9 | 25 | 31 |
10 to 19 | 25 | 31 |
>20 | 17 | 21 |
Specialty | ||
Gastroenterology/hepatology | 33 | 41 |
Infectious disease | 17 | 21 |
Pharmacy | 13 | 16 |
Primary care | 8 | 10 |
Other (VERC, transplant) | 9 | 11 |
Degree | ||
PharmD | 35 | 44 |
NP | 13 | 16 |
MD | 11 | 14 |
PA | 5 | 6 |
RN | 2 | 3 |
Other | 14 | 18 |
Site complexity | ||
1a | 27 | 33 |
1b | 14 | 18 |
1c | 12 | 15 |
2 | 14 | 18 |
3 | 12 | 15 |
Implementation strategy clusters | Number of strategies | Number of Endorsements (number per strategy in cluster) | Correlation between number of strategies used within the cluster and treatment starts |
R
2
|
P value | Number (%) of strategies in the cluster associated with treatment starts |
---|---|---|---|---|---|---|
Provide interactive assistance | 4 | 75 (19) | 0.46 | 21% | <0.001 | 3 (75%) |
Develop stakeholder relationships | 17 | 405 (24) | 0.44 | 20% | <0.001 | 11 (64%) |
Train and educate stakeholders | 11 | 349 (32) | 0.33 | 11% | 0.003 | 5 (45%) |
Adapt and tailor to context | 4 | 208 (52) | 0.31 | 10% | 0.004 | 0 (0%) |
Change infrastructure | 8 | 211 (26) | 0.29 | 9% | 0.008 | 4 (50%) |
Support clinicians | 5 | 187 (37) | 0.29 | 8% | 0.009 | 3 (60%) |
Engage consumer | 5 | 193 (39) | 0.27 | 7% | 0.016 | 1 (20%) |
Financial strategies | 9 | 141 (16) | 0.26 | 7% | 0.020 | 0 (0%) |
Use evaluative and iterative strategies | 10 | 191 (19) | 0.23 | 5% | 0.043 | 1 (10%) |
Quadrant | Description | Number of strategies in quadrant | Number of endorsements of strategies in quadrant by respondents | Endorsements per strategy | Number of strategies associated with treatment starts in quadrant (% of strategies in quadrant) | Correlation between number strategies used in quadrant and treatment starts r (p) | Correlation between number strategies used in quadrant and number viremic r (p) |
---|---|---|---|---|---|---|---|
1 | High importance, high feasibility | 31 | 966 | 31 | 10 (32%) | 0.35 (0.002) | 0.38 (<0.001) |
2 | Low importance, high feasibility | 11 | 215 | 20 | 5 (45%) | 0.37 (<0.001) | 0.38 (<0.001) |
3 | Low importance, low feasibility | 22 | 542 | 25 | 9 (41%) | 0.44 (<0.001) | 0.37 (<0.001) |
4 | High importance, low feasibility | 9 | 293 | 33 | 4 (44%) | 0.44 (<0.001) | 0.41 (<0.001) |
Top treating quartile | Cluster | N | Quadrant | Bottom treating quartile | Cluster |
N
| Quadrant |
---|---|---|---|---|---|---|---|
Revise professional rolesa
| Support clinicians | 14 | 3 | Intentionally examine the efforts to promote HCV care | Evaluative | 9 | 1 |
Identify and prepare championsa
| Interrelationships | 14 | 1 | Place HCV medications on the formulary | Financial | 13 | 4 |
Tailor strategies to deliver HCV care | Tailor | 15 | 1 | Provide ongoing consultation with one or more HCV treatment experts | Train/educate | 9 | 1 |
Engage in efforts to prepare patients to be active participants in HCV carea
| Consumers | 16 | 4 | Mandate changes to HCV care | Infrastructure | 13 | 3 |
Change the record systems | Infrastructure | 14 | 3 | Develop reminder systems for clinicians | Support | 9 | 2 |
Intervene with patients/consumers to promote uptake and adherence to HCV treatment | Consumers | 17 | 4 | Intervene with patients/consumers to promote uptake and adherence to HCV treatment | Consumers | 14 | 4 |
Use data warehousing techniques | Tailor | 19 | 3 | Use data warehousing techniques | Tailor | 16 | 3 |
Distribute educational materials | Train/educate | 14 | 1 | Distribute educational materials | Train/educate | 9 | 1 |
Facilitate the relay of clinical data to providers | Support | 15 | 1 | Facilitate the relay of clinical data to providers | Support | 11 | 1 |
Build on existing high-quality working relationships and networks to promote information sharing and problem solving related to implementing HCV carea
| Interrelationships | 15 | 3 | Build on existing high-quality working relationships and networks to promote information sharing and problem solving related to implementing HCV carea
| Interrelationships | 9 | 3 |