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Using Formative Evaluation to Translate Quality Improvement in HIV Care

Bowman C, Anaya H, Asch S, Patterson E, Fremont A, Joyce G. Using Formative Evaluation to Translate Quality Improvement in HIV Care. Paper presented at: VA QUERI National Meeting; 2003 Dec 10; Washington, DC.

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Objectives: A goal of QUERI-HIV/AIDS is to enhance provider delivery of guideline-based HIV care. We tested (1) computerized clinical reminders and (2) a group-based social support activity, modeled on the IHI Breakthrough Collaboratives, for occurrence of HIV-related best practices for predicting success of future rollouts. We employed formative evaluation methods to better understand the use by providers within the context of their normal work.Methods/Approach: (1) Ten clinical reminders related to HIV care were installed on the VA's electronic medical record system at eight VA facilities. To evaluate use, we employed a human factors expert in assessment of the human-machine interface. (2) The IHI-style intervention, designed to facilitate small scope, rapid cycle quality improvement efforts, includes face-to-face learning sessions to educate and encourage participating staff. Site activation, or 'buy-in', and staff satisfaction were measured by survey and exit interviews. (3) We performed a cost/benefit analysis of the time and labor costs associated with staff participation for both interventions.Results/Findings: (1) Qualitative observations of provider responses to the pop-up reminders resulted in more than 50 recommendations for organizational and design modifications that would improve the effectiveness of this clinical tool. (2) Results indicated variable performance in QI activity related to degree of activation. Survey findings revealed that higher performing sites perceived greater usefulness of the activities and, despite increased workload, more work satisfaction. (3) Amount of time that each staff member spent on the intervention that they implemented was small. The average per site cost of yearlong participation in the IHI-style intervention was $6,000 compared to $30,000 for the implementation of the clinical reminders.Implications: Formative evaluations of QI interventions provide opportunities for refinement prior to system-wide rollout. Analyzing the cost of participation/implementation can reveal useful, low burden tools.

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