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Organizational Correlates of Quality Improvement Activities in Veterans Administration HIV Clinics

Anaya H, Yano EM, Asch SM. Organizational Correlates of Quality Improvement Activities in Veterans Administration HIV Clinics. Paper presented at: Society of General Internal Medicine Annual Meeting; 2003 May 2; Vancouver, Canada.

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Background To examine the relationship between organizational characteristics of VA HIV/AIDS clinic and quality improvement (QI) activities including clinical reminders (CR) and QI groups.Methods The source of data was the 2001 VHA Survey of HIV Programs and Practices, conducted by the Quality Enhancement Research Initiative (QUERI) for HIV/AIDS. One hundred and eighteen lead clinicians described organizational characteristics and QI activities (response rate = 86%). Organizational characteristics included urban/rural location, geographic region, facility complexity, readiness to change, HIV caseload, HIV case management, and barriers to care. Multivariate analysis predicted quality improvement programming and use of HIV care guidelines, as well as perceived effectiveness of QI modalities including CR and QI groups, and facility and provider profiling.Results Approximately 13% of facilities had implemented an HIV QI program; 48% of facilities employed guidelines for HIV patient care. QI groups (3.45), and CR (3.42) had significantly higher perceived effectiveness than facility profiling (2.57) or provider profiling (2.52) (coded 1 (least effective) to 5 (most effective)). Facilities with greater numbers of HIV-positive patients were more likely to employ guidelines for HIV care. Providers at western VA facilities were more likely to think that CR and QI groups were effective than providers from the eastern, southern, and central regions. Providers from facilities with higher complexity were more likely to view CR and QI groups as effective. Conclusion Many VA HIV clinics have not yet adopted formal QI programs. As the VA and other healthcare organizations move to implement QI interventions, attention should be paid to factors affecting that implementation. Our data support two common methods, CR and QI groups, in HIV care. The association of region and facility complexity on the perceived effectiveness of both interventions should guide the VA as it moves toward systematic QI implementation.

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