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2015 HSR&D/QUERI National Conference Abstract

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1074 — Evidence-Based Practice and Patient-Centered Care: Doing Both Well

Engle RL, VA Boston, CHOIR; Mohr DC, VA Boston, CHOIR; Nealon Seibert M, VA Boston, CHOIR; Holmes SK, VA Boston, CHOIR; Boston University; Afable MK, VA Boston, CHOIR; Boston University; Meterko M, VA Boston, CHOIR;

Objectives:
This study expands the understanding of the relationship between evidence-based practice (EBP) and patient-centered care (PCC) by answering the following questions: 1) What are the key characteristics that distinguish facilities that are able to provide inpatient care that is both evidence-based and patient-centered from facilities where performance is mixed or low in both domains? 2) What specific behavioral and process mechanisms distinguish organizations that provide both evidence-based and patient-centered care?

Methods:
We conducted 142 semi-structured interviews with all levels of staff at 12 Veterans Affairs Medical Centers (VAMCs). EBP was assessed by facility-level inpatient quality indicator scores; PCC was assessed by facility-level inpatient survey measures. The participating VAMCs fell into four relative performance quadrants: High EBP/High PCC, High EBP/Low PCC, Low EBP/ High PCC, and Low EBP/Low PCC. Interview data were qualitatively analyzed using a priori constructs consistent with organizational literature, as well as emergent themes.

Results:
High-performing sites in both domains had an active, innovative, improvement-oriented culture emphasizing individual accountability and staff engagement in problem solving. Providers at high-performing facilities had the institutional support and autonomy to provide clinical care that was evidence-based and emphasized patient and family preferences. Further, high-performing sites took multidisciplinary approaches to care in which team members equally shared responsibility for patient care, and communication was open and multidirectional among all levels of the organization, including veterans. In contrast, low-performing sites had more punitive cultures characterized by lack of individual accountability, greater passivity, and resistance to change. Providers in low-performing facilities often aspired to improve clinical performance and patient centeredness, but felt bound by existing institutional structures and systems. These sites also had more formalized and hierarchical approaches to providing multidisciplinary care, with structured or strained communication between various levels of the organization.

Implications:
This study generated knowledge about organizational characteristics and staff behaviors that could be strengthened to facilitate the delivery of care that is both evidence based and patient centered.

Impacts:
Recognizing that organizational culture is difficult to change, these findings nonetheless highlight areas for the VA to consider when striving to deliver care that is both evidence based and patient centered.