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Health Services Research & Development

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2006 HSR&D National Meeting Abstract

1066 — Sustained Use of Implemented Quality Improvement in VA HIV Care

Author List:
Bowman CC (VA San Diego Healthcare System)
Hoang TK (VA Greater Los Angeles Healthcare System)
Saleem J (VA Cincinnati Healthcare System)
Halloran J (VA San Antonio Healthcare System)
Anaya HD (VA Greater Los Angeles Healthcare System)
Patterson E (VA Cincinnati Healthcare System)
Gifford AL (VA San Diego Healthcare System)
Goetz M (VA Greater Los Angeles Healthcare System)
Asch SA (VA Greater Los Angeles Healthcare System)

We conducted a study of two QI interventions targeting provider performance on guideline-based care for treating HIV disease (results reported elsewhere). To ascertain whether the interventions became part of routine care, we measured the same outcomes for one additional year and evaluated continued intervention use.

In the main study, we implemented either clinical reminders, a modified Breakthrough Series collaborative, or both at 16 VA facilities in a 4-arm quasi-experiment and measured receipt of 10 aspects of guideline-based HIV care. For the sustainability analysis, we measured percentages of eligible patients who received each aspect of care and patients who received all aspects of care for which they were eligible, or optimal quality care (Q score). We interviewed key informants selected from six sites exposed to either one or both of the interventions about continued use at their facilities.

Odds of patients receiving indicated care compared to controls in the reminders-only and combined sites improved on more care indicators (5/10) than the collaborative-only sites (0/10) during the sustainability period; a similar pattern was shown in the Q scores (reminders=OR 2.48, combined=OR 2.24, p=.05). Raw percentages of patients receiving indicated care remained above baseline for 5 aspects of care in the reminder-only sites, 6 aspects in the collaborative-only sites, and 6 in the combined sites. Qualitative results indicated that nearly all sites were using at least some reminders in the year after the study period. Collaborative methods were still being used but only at the most activated of the original study sites.

HIV clinical reminders alone and combined with a modified collaborative significantly improved receipt of HIV quality care for one year after the study’s end, indicating that these interventions have become part of routine HIV care delivery at the target sites.

These findings confirm that implementation projects can be important mechanisms for ensuring that QI interventions improve care delivery and actually become integrated into routine use. However, limiting exposure to the interventions in control sites in a follow-up analysis can make this process difficult to assess.

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