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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1087 — Organizational Factors Affecting the Likelihood of Cancer Screening among VA Patients

Chou AFRose DFarmer MCanelo I, and Yano EM, VA Greater Los Angeles Healthcare System;

The implementation of organizational processes addressing quality improvement (QI) and dedication of resources have been hypothesized to predict better clinical outcomes. Nevertheless, little empirical evidence exists establishing a relationship between organizational support/resources and quality outcomes. This study aims to understand the role of organizational factors in achieving cancer screening.

This study employed a cross-sectional design. The analytic dataset included: (1) VA Clinical Practice Organizational Survey (CPOS) with a national sample of 225 VA primary care directors, (2) External Peer Review Program performance measures for preventive services, and (3) Area Resource Files containing facility characteristics. Organizational process measures were constructed from the CPOS survey, using factor analyses to generate scores describing the extent to which the facility has authority, communication/cooperation, QI process, computerized patient record system, competing demands, resource sufficiency in personnel/finances, clinical staff, support staff, space/equipment, and patient care support. Three preventive service measures, breast (BCS), cervical (PCS), and colorectal cancer screening (CCS), were studied. Random-effects logistic regression analyses modeled cancer screening as a function of organizational process scores, controlling for patient demographic (e.g., age, gender, race/ethnicity) and facility characteristics (size, rurality, geography, academic affiliation).

Findings showed that increased QI process adoption and resource sufficiency are associated with higher likelihood of cancer screening. QI process implementation increased the likelihood of PCS (OR = 1.31, 95% CI:1.06-1.61) and CCS (OR = 1.14, 95% CI:1.04-1.24). Sufficient clinical staffing increased the likelihood of BCS (OR = 1.17, 95% CI:1.03-1.33) and CCS (OR = 1.20, 95% CI:1.02-1.40). Sufficient personnel/financial resources was associated with increased CCS (OR = 1.13, 95% CI:1.04-1.23). Sufficient support staffing had a negative relationship with BCS (OR = 0.85, 95% CI:0.74-0.98) and CCS (OR = 0.81, 95% CI:0.85-0.99).

QI efforts and resource sufficiency have important implications for care provision and service delivery. Organizational emphasis on QI and sufficient personnel resources led to increased compliance with screening because they promote excellence in patient care by conveying to organizational actors the organizational goals and foci, facilitating goal achievement.

Identifying organizational processes associated with better performance may offer some concrete strategies in which facilities can evaluate their current capabilities to implement effective processes/practices to improve preventive service delivery and foster and sustain a culture of providing quality care.

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