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Impact of Primary Care Resources on Prevention Practices in the VHA
Soban LM, Lanto AB, Yano EM. Impact of Primary Care Resources on Prevention Practices in the VHA. Paper presented at: VA HSR&D National Meeting; 2004 Mar 10; Washington, DC.
Objectives: Organizational and systems factors can influence the delivery of preventive care. We evaluated the relationship between sufficiency of primary care resources and the delivery of the 9 preventive services tracked by the External Peer Review Program (EPRP).Methods: We used data from two sources: (1) survey data from the VHA survey of Primary Care Practices, 1999 and (2) performance measure data for 9 preventive services from the EPRP. Principal Components Analysis (PCA) was performed on the survey data to derive resource sufficiency scales. Bivariate and multivariate analyses were performed to assess the relationship of resource sufficiency to preventive care delivery.Results: PCA indicated three dimensions of sufficiency: space (alpha = .85), equipment (alpha = .81), and staff (alpha = .69). Facility scores were computed for each dimension. Bivariate analysis indicated that a facility's equipment sufficiency was significantly and positively associated with the delivery of 6 of 9 preventive services (pneumococcal and influenza immunizations; prostate cancer screening (education); cervical and colorectal cancer screening; and screening for hyperlipidemia,). Neither sufficiency of space nor sufficiency of staff was significantly associated with any of the prevention indices. After adjusting for facility size and academic affiliation, equipment sufficiency remained a significant independent predictor of CRC screening, cervical cancer screening, screening for hyperlipidemia, and prostate cancer screening education.Conclusions: The sufficiency of primary care resources is an often overlooked but important predictor of preventive services delivery in the VHA.Impact: Not assuring the sufficiency of primary care resources may undermine prevention performance.