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CDA 07-018 – HSR&D Study

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CDA 07-018
Organizational Correlates of Outpatient Performance Trends in VAMCs
Sylvia J. Hysong PhD MA BA
Michael E. DeBakey VA Medical Center, Houston, TX
Houston, TX
Funding Period: July 2008 - June 2013

BACKGROUND/RATIONALE:
VA has led the industry in measuring facility performance as a critical element to improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. VA's External Peer Review Program (EPRP) is the official data source for monitoring facility performance, used by the Office of Informatics and Analytics (OIA) to prioritize the quality areas needing most attention. Though facility performance measurement has significantly improved VA's quality of care, research has noted that improvements are greatest only in areas where VA has specifically monitored performance. This research examines changes in facility performance when specific quality measures change status from actively evaluated (called "performance measures" (PM) by OIA) by to not actively evaluated ("support indicators" (SI)) and vice versa, and explores organizational mechanisms that could explain the observed performance changes.

OBJECTIVE(S):
(1) Compare the nature and rate of change in EPRP measure scores at VAMCs as a function of a measure's performance evaluation status (PM vs. SI), and identify organizational factors that explain this change; (2) Explore how leaders at high and low performing facilities use EPRP data to maintain and improve performance at their facilities.

METHODS:
OBJECTIVE 1: Quantitative, retrospective analysis of EPRP quality indicators and organizational measures from VA's Inventory of Organizational Characteristics. The magnitude and rate of facility performance change was tested across 17 quality indicators that have been both PMs and SIs for at least two years each, using hierarchical linear modeling. This hierarchical model was then expanded to test for the moderating effect of facility characteristics and practices, such as availability of individual-level performance data.

OBJECTIVE 2: Qualitative, grounded theory analysis of 48 interviews with primary care, facility and VISN leadership of high and low performing facilities. Interviews were be analyzed for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness of feedback delivery. Changes in feedback delivery strategies as a result of facilities' transitions to team-based care were also explored.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
VA's performance management system continues to grow as new measures are developed and existing measures are modified. Effective use of this system is highly dependent on VA's ability to interpret, consume, and feedback those data effectively, particularly given the transition to a team-based model of care. Findings from this research will help improve science and practice by enhancing our understanding of how best to measure, monitor, and reward facility performance in outpatient care.

PUBLICATIONS:

Journal Articles

  1. Hysong SJ, Smitham K, SoRelle R, Amspoker A, Hughes AM, Haidet P. Mental models of audit and feedback in primary care settings. Implementation science : IS. 2018 May 30; 13(1):73.
  2. Hysong SJ, Kell HJ, Petersen LA, Campbell BA, Trautner BW. Theory-based and evidence-based design of audit and feedback programmes: examples from two clinical intervention studies. BMJ quality & safety. 2017 Apr 1; 26(4):323-334.
  3. Powell AA, White KM, Partin MR, Halek K, Hysong SJ, Zarling E, Kirsh SR, Bloomfield HE. More than a score: a qualitative study of ancillary benefits of performance measurement. BMJ quality & safety. 2014 Aug 1; 23(8):651-8.
  4. Hysong SJ, Simpson K, Pietz K, SoRelle R, Broussard Smitham K, Petersen LA. Financial incentives and physician commitment to guideline-recommended hypertension management. The American journal of managed care. 2012 Oct 1; 18(10):e378-91.
  5. Hysong SJ, Teal CR, Khan MJ, Haidet P. Improving quality of care through improved audit and feedback. Implementation science : IS. 2012 May 18; 7(1):45.
  6. Powell AA, White KM, Partin MR, Halek K, Christianson JB, Neil B, Hysong SJ, Zarling EJ, Bloomfield HE. Unintended consequences of implementing a national performance measurement system into local practice. Journal of general internal medicine. 2012 Apr 1; 27(4):405-12.
  7. Petersen LA, Urech T, Simpson K, Pietz K, Hysong SJ, Profit J, Conrad D, Dudley RA, Lutschg MZ, Petzel R, Woodard LD. Design, rationale, and baseline characteristics of a cluster randomized controlled trial of pay for performance for hypertension treatment: study protocol. Implementation science : IS. 2011 Oct 3; 6(1):114.
  8. Hysong SJ, Khan MM, Petersen LA. Passive monitoring versus active assessment of clinical performance: impact on measured quality of care. Medical care. 2011 Oct 1; 49(10):883-90.
  9. Hysong SJ, Esquivel A, Sittig DF, Paul LA, Espadas D, Singh S, Singh H. Towards successful coordination of electronic health record based-referrals: a qualitative analysis. Implementation science : IS. 2011 Jul 27; 6:84.
  10. Trautner BW, Kelly PA, Petersen N, Hysong S, Kell H, Liao KS, Patterson JE, Naik AD. A hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of catheter-associated asymptomatic bacteriuria. Implementation science : IS. 2011 Apr 22; 6(1):41.
  11. Hysong SJ, Sawhney MK, Wilson L, Sittig DF, Esquivel A, Singh S, Singh H. Understanding the management of electronic test result notifications in the outpatient setting. BMC medical informatics and decision making. 2011 Apr 12; 11:22.
  12. Hysong SJ, Sawhney MK, Wilson L, Sittig DF, Espadas D, Davis T, Singh H. Provider management strategies of abnormal test result alerts: a cognitive task analysis. Journal of the American Medical Informatics Association : JAMIA. 2010 Jan 1; 17(1):71-7.
  13. Hysong SJ, Sawhney MK, Wilson L, Sittig DF, Esquivel A, Watford M, Davis T, Espadas D, Singh H. Improving outpatient safety through effective electronic communication: a study protocol. Implementation science : IS. 2009 Sep 25; 4:62.
  14. Hysong SJ. Meta-analysis: audit and feedback features impact effectiveness on care quality. Medical care. 2009 Mar 1; 47(3):356-63.
  15. Hysong SJ. The role of technical skill perceptions of managerial performance. Journal of Management Development. 2008 Mar 1; 27(3):275-290.
  16. Cronshaw F, Best G, Hysong J, Moore I, Warner, Zune. A validation model for functional job analysis task banks. Ergometrika. 2007 Oct 15; 4(1):12-31.
Conference Presentations

  1. Hysong SJ, Khan M, Amspoker A, Petersen LA. The role of interaction among clinical personnel on outpatient clinical performance. Poster session presented at: VA HSR&D National Meeting; 2012 Jul 16; Washington, DC.
  2. White DL, Hysong SJ. An introduction to conducting and interpreting meta-analyses. Presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 16; National Harbor, MD.
  3. Hysong SJ, Broussard K, Knox M, Johnson K, Stelljes L, Gribble G, SoRelle R, Haidet P. Recruiting clinical personnel as research participants: A framework for estimating feasibility. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 25; Boston, MA.
  4. Hysong SJ, Khan MJ, Amspoker AB, Petersen LA. All clinical performance measures are not created equal: The role of interaction among clinical personnel on measured performance. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 25; Boston, MA.
  5. Hysong SJ, Simpson K, Pietz K, Petersen LA. Financial incentives and goal commitment: Mixed methods study. Poster session presented at: Society for Industrial and Organizational Psychology Annual Conference; 2012 Apr 27; San Diego, CA.
  6. Hysong SJ, Spitzmuller C, Espadas D, Singh H. Impact of workplace support systems for electronic alert notifications. Poster session presented at: Society for Industrial and Organizational Psychology Annual Conference; 2012 Apr 27; San Diego, CA.
  7. Hysong SJ, Espadas DD, Burnett C, Singh H. Is there an organizational scientist in the house?: How the science of I-O is helping healthcare enter a new era. Poster session presented at: Society for Industrial and Organizational Psychology Annual Conference; 2012 Apr 26; San Diego, CA.
  8. Hysong SJ. Post-doctoral fellowships in Health Services Research. Paper presented at: AcademyHealth Annual Research Meeting; 2011 Jun 13; Seattle, WA.
  9. Petersen LA, Simpson K, Woodard LD, Pietz KC, Urech TH, Lutschg MZ, Hysong SJ. Do financial incentives for guideline adherence improve care of hypertension in the primary care setting: A multi-Site RCT. Paper presented at: AcademyHealth Annual Research Meeting; 2011 Jun 13; Seattle, WA.
  10. Petersen LA, Simpson K, Woodard LD, Pietz KC, Urech TH, Zimmer M, Hysong SJ, Conrad D, Profit J, Dudley RA. Do financial incentives for guidelines adherence improve care of hypertension in the primary care setting? A multi-site RCT. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2011 May 4; Phoenix, AZ.
  11. Charles K, Eurich T, Howes J, Hysong SJ, Krauss A, Payne H. Industry spotlight: How I-O can help solve the healthcare crisis. Paper presented at: Society for Industrial and Organizational Psychology Annual Conference; 2011 Apr 14; Chicago, IL.
  12. Powell AA, Partin MR, Halek KE, Christianson JB, Hysong SJ, Neil BJ, Bloomfield HE. A Qualitative Study of the Unintended Effects of Performance Measurement in VHA Primary Care. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.
  13. Hysong SJ. Organizational correlates of outpatient performance trends in VAMCs. Paper presented at: VA HSR&D National Meeting; 2011 Feb 16; Washington, DC.
  14. White DL, Hysong SJ. An introduction to conducting and interpreting meta-analyses. Presented at: VA HSR&D National Meeting; 2011 Feb 16; Washington, DC.
  15. Petersen LA, Simpson K, Urech T, Woodard L, Hysong S, Dudley RA. Incorporating equity into quality improvements agendas. Paper presented at: RWJ Foundation Aligning Forces for Quality National Meeting; 2010 Nov 18; Orlando, FL.
  16. Powell AA, White KM, Partin MR, Halek KE, Christianson J, Hysong S, Neil BJ, Bloomfield HE. Unintended Effects of Performance Measurement in VA Primary Care. Poster session presented at: AcademyHealth Annual Research Meeting; 2010 Jun 28; Boston, MA.
  17. Powell AA, White KM, Partin MR, Halek KE, Christianson JB, Hysong SJ, Neil BJ, Bloomfield HE. Unintended Effects of Performance Measurement in VA Primary Care. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2010 Apr 29; Minneapolis, MN.
  18. Hysong SJ, Esquivel A, Wilson L, Watford M, Espadas D, Singh H. Using electronic medical records for referrals: Beyond the interface. Poster session presented at: Society for Industrial and Organizational Psychology Annual Conference; 2010 Apr 8; Atlanta, GA.
  19. Hysong SJ, Khan MK. Does Linking Performance Measures to Hospital Budgets Improve their Outpatient Clinical Performance? Poster session presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL.
  20. Hysong SJ, Wilson L, Sawhney M, Sitting D, Espadas D, Davis T, Singh H. How do providers manage their diagnostic test results alerts? Implications for medical error reduction through electronic medical records. Poster session presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL.
  21. Petersen LA, Simpson K, Urech T, Woodard L, Hysong S, Dudley RA. Do financial incentives to health care providers generate greater interest in adhering to performance measures than audit and feedback alone? Poster session presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL.
  22. Sawhney MK, Sittig DF, Petersen LA, Thomas EJ, Hysong SJ, Singh H. Improving Outpatient Safety through Effective Electronic Communication. Poster session presented at: Agency for Healthcare Research and Quality National Research Service Award Trainees Research Conference; 2009 Jun 27; Chicago, IL.
  23. Hysong SJ, White DL. An Introduction to Conducting and Interpreting Meta-Analyses. Presented at: European Association of Work and Organizational Psychology Biennial Workshop; 2009 May 13; Santiago de Compostela, Spain.
  24. Petersen LA, Simpson K, Urech T, Woodard L, Hysong S, Dudley RA. Do financial incentives to health care providers generate greater interest in adhering to performance measures than audit and feedback alone? Poster session presented at: Society of General Internal Medicine Annual Meeting; 2009 May 13; Miami, FL.
  25. Best RG, Hysong SJ, Ohly S, Spitzmuller C. Using archival datasets: Opportunities and pitfalls for I/O psychologists. Paper presented at: Society for Industrial and Organizational Psychology Annual Conference; 2009 Apr 9; New Orleans, LA.
  26. Hysong SJ, Avery DA. Predicting Skill Variety: Interactive Effects of Sex and Tenure. Poster session presented at: Society for Industrial and Organizational Psychology Annual Conference; 2009 Apr 9; New Orleans, LA.
  27. Hysong SJ, Petersen LA. Provider Knowledge and Attitudes Toward Hypertension Guidelines Impact Implementation of Evidence-Based Care. Paper presented at: National Heart, Lung, and Blood Institute's Cardiovascular Diversity Research Supplement Awardee Annual Session; 2008 Nov 8; New Orleans, LA.
  28. Hysong SJ. Meta-analysis: Audit & Feedback Features Impact their Effectiveness on Quality of Care. Paper presented at: AcademyHealth Annual Research Meeting; 2008 Jun 8; Washington, DC.
  29. Hysong SJ, Kelly PA, Woodard L, Petersen LP. Prioritizing Quality of Care in VA Medical Centers: Should We Concentrate on Diseases or Processes? Paper presented at: AcademyHealth Annual Research Meeting; 2008 Jun 8; Washington, DC.
  30. Hysong J. Tech Tools for Conducting Research: Old Friends and New Acquaintances. Paper presented at: Foundations in Health Services Research Annual Seminar; 2008 May 29; Houston, TX.
  31. Hysong SJ, Best RG, Moore FI, Cronshaw SF. Social and Cognitive Biases in Alternative Task-Oriented Work Analysis Methods. Paper presented at: Society for Industrial and Organizational Psychology Annual Conference; 2008 Apr 8; San Francisco, CA.


DRA: Health Systems
DRE: none
Keywords: none
MeSH Terms: none

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