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2019 HSR&D/QUERI National Conference Abstract

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4133 — Spread of Quality Improvement Projects Implemented in a Geriatrics Workforce Development Program

Lead/Presenter: Claire O'Hanlon,  COIN - Los Angeles
All Authors: O'Hanlon CE (VA Center for the Study of Healthcare Innovation, Implementation & Policy), Saliba D (VA Center for the Study of Healthcare Innovation, Implementation & Policy; University of California, Los Angeles Borun Center for Gerontological Research), Douglas J (VA Greater Los Angeles Healthcare System Geriatric Research Education Clinical Center [contractor]) Mitchell MN (VA Center for the Study of Healthcare Innovation, Implementation & Policy) Kramer BJ (VA Greater Los Angeles Healthcare System Geriatric Research Education Clinical Center; Division of Geriatric Medicine, David Geffen School of Medicine at UCLA)

To characterize spread of quality improvement (QI) projects initiated in the VA Geriatric Scholars Program (GSP) workforce development program, which aims to improve access to high quality care for geriatric populations, especially in rural areas. 931 GSP participants (32% physicians, 25% nurses, 16% pharmacists, 11% psychologists, 9% social workers, 4% physician assistants, 3% rehab therapists) have enrolled since inception. The GSP curriculum includes didactic education in geriatrics and QI methods, and initiation of a capstone QI project of the scholar's choice. We aim to understand the extent to which QI projects are sustained beyond the initial implementation period and spread to other care teams.

This mixed methods study analyzes a recent cross-sectional survey of GSP participants and program-level data on participant characteristics and QI project topics. We surveyed 578 scholars, had completed all program requirements to that point, and still worked for VA; 207 (36%) responded.

The majority of survey respondents who had been in the program for at least six months (70%) reported sustainment of their QI project beyond the initial implementation. Nearly a third (30.4%) of respondents reported any spread beyond their own care team. About a fifth (20.3%) were adopted by other teams in the scholar's clinic, 9.7% were adopted by home-based primary care teams in their local health care system, and 5.8% were adopted at other facilities. QI project topics spanned many domains and percent of projects reporting spread varied across domains from 0% to 67%.

The GSP's impacts on quality of primary care extend beyond participants' own care teams through the spread of scholars' QI projects. The majority of projects are sustained beyond the implementation pilot period and a large proportion spread to other care teams.

A workforce development capstone activity in which participants demonstrate substantive and methodological competency can foster bottom-up QI activities in a large, diverse health care system. The program has impacts beyond the individual participants and primary care practices. Future work will investigate the processes by these projects are sustained and spread and how these processes can be enhanced in VA and other health care systems.