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Variations in Informatics Technology Implementation in VHA to Improve Care

Doebbeling BN, Vaughn TE, McCoy KD, Glassman P. Variations in Informatics Technology Implementation in VHA to Improve Care. Paper presented at: VA HSR&D National Meeting; 2004 Mar 10; Washington, DC.


Objectives: We evaluated information technology (IT) implementation in VHA facilities for quality improvement (QI) and sought to identify organizational factors influencing implementation and provider use.Methods: We surveyed clinicians from a stratified random national sample of VHA providers (MDs, RNs, NPs/PAs). Respondents rated the availability of IT support across six dimensions (rated 1-5) recommended by the Institute of Medicine at their facility using Likert scales. Factor analysis demonstrated a single factor, IT clinical support. AHA and VA quality manager surveys were linked to provide predictors in three domains (organizational context, change management, QI culture). Hierarchical models were estimated.Results: 1777 providers at 123 hospitals participated. Provider groups assessed IT clinical support slightly differently. Mean scores for the dimensions were 1) computerized patient clinical data (mean 4.3); 2) electronic communication between providers (4.1); 3) automation of decisions to reduce errors (3.8); 4) access to literature/evidence based medicine while delivering care (mean 3.4); and 5) decision support systems (3.2); and 6) electronic communication with patients (2.4). IT clinical support was positively associated with urban location (p < 0.05), and cooperative culture (p < 0.01). Staffing ratios, hospital type, and change management measures were unrelated to IT clinical support.Conclusions: VA's adoption of IT to support improved quality of care varies across recommended dimensions of technology. Further study is needed to identify the dimensions that contribute most to improved quality and how to effectively implement them.Impact: The VA's national electronic medical record provides important opportunities for more widely adapting IT to support effective delivery of care.

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