Organizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration
© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply..
BACKGROUND: The Veterans Health Administration provides care to more than 100,000 Veterans with cirrhosis.
AIMS: This implementation evaluation aimed to understand organizational resources and barriers associated with cirrhosis care.
METHODS: Clinicians across 145 Department of Veterans Affairs (VA) medical centers (VAMCs) were surveyed in 2022 about implementing guideline-concordant cirrhosis care. VA Corporate Data Warehouse data were used to assess VAMC performance on two national cirrhosis quality measures: HCC surveillance and esophageal variceal surveillance or treatment (EVST). Organizational factors associated with higher performance were identified using linear regression models.
RESULTS: Responding VAMCs (n = 124, 86%) ranged in resource availability, perceived barriers, and care processes. In multivariable models, factors independently associated with HCC surveillance included on-site interventional radiology and identifying patients overdue for surveillance using a national cirrhosis population management tool ("dashboard"). EVST was significantly associated with dashboard use and on-site gastroenterology services. For larger VAMCs, the average HCC surveillance rate was similar between VAMCs using vs. not using the dashboard (47% vs. 41%), while for smaller and less resourced VAMCs, dashboard use resulted in a 13% rate difference (46% vs. 33%). Likewise, higher EVST rates were more strongly associated with dashboard use in smaller (55% vs. 50%) compared to larger (57% vs. 55%) VAMCs.
CONCLUSIONS: Resources, barriers, and care processes varied across diverse VAMCs. Smaller VAMCs without specialty care achieved HCC and EVST surveillance rates nearly as high as more complex and resourced VAMCs if they used a population management tool to identify the patients due for cirrhosis care.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Digestive diseases and sciences - (2024) vom: 14. Apr. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
McCurdy, Heather [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 14.04.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1007/s10620-024-08409-6 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM371055393 |
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| 245 | 1 | 0 | |a Organizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration |
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| 500 | |a published: Print-Electronic | ||
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| 520 | |a © 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply. | ||
| 520 | |a BACKGROUND: The Veterans Health Administration provides care to more than 100,000 Veterans with cirrhosis | ||
| 520 | |a AIMS: This implementation evaluation aimed to understand organizational resources and barriers associated with cirrhosis care | ||
| 520 | |a METHODS: Clinicians across 145 Department of Veterans Affairs (VA) medical centers (VAMCs) were surveyed in 2022 about implementing guideline-concordant cirrhosis care. VA Corporate Data Warehouse data were used to assess VAMC performance on two national cirrhosis quality measures: HCC surveillance and esophageal variceal surveillance or treatment (EVST). Organizational factors associated with higher performance were identified using linear regression models | ||
| 520 | |a RESULTS: Responding VAMCs (n = 124, 86%) ranged in resource availability, perceived barriers, and care processes. In multivariable models, factors independently associated with HCC surveillance included on-site interventional radiology and identifying patients overdue for surveillance using a national cirrhosis population management tool ("dashboard"). EVST was significantly associated with dashboard use and on-site gastroenterology services. For larger VAMCs, the average HCC surveillance rate was similar between VAMCs using vs. not using the dashboard (47% vs. 41%), while for smaller and less resourced VAMCs, dashboard use resulted in a 13% rate difference (46% vs. 33%). Likewise, higher EVST rates were more strongly associated with dashboard use in smaller (55% vs. 50%) compared to larger (57% vs. 55%) VAMCs | ||
| 520 | |a CONCLUSIONS: Resources, barriers, and care processes varied across diverse VAMCs. Smaller VAMCs without specialty care achieved HCC and EVST surveillance rates nearly as high as more complex and resourced VAMCs if they used a population management tool to identify the patients due for cirrhosis care | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Barriers | |
| 650 | 4 | |a Dashboard | |
| 650 | 4 | |a HCC | |
| 650 | 4 | |a Liver care | |
| 650 | 4 | |a Varices | |
| 700 | 1 | |a Nobbe, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Scott, Dawn |e verfasserin |4 aut | |
| 700 | 1 | |a Patton, Heather |e verfasserin |4 aut | |
| 700 | 1 | |a Morgan, Timothy R |e verfasserin |4 aut | |
| 700 | 1 | |a Bajaj, Jasmohan S |e verfasserin |4 aut | |
| 700 | 1 | |a Yakovchenko, Vera |e verfasserin |4 aut | |
| 700 | 1 | |a Merante, Monica |e verfasserin |4 aut | |
| 700 | 1 | |a Gibson, Sandra |e verfasserin |4 aut | |
| 700 | 1 | |a Lamorte, Carolyn |e verfasserin |4 aut | |
| 700 | 1 | |a Baffy, Gyorgy |e verfasserin |4 aut | |
| 700 | 1 | |a Ioannou, George N |e verfasserin |4 aut | |
| 700 | 1 | |a Taddei, Tamar H |e verfasserin |4 aut | |
| 700 | 1 | |a Rozenberg-Ben-Dror, Karine |e verfasserin |4 aut | |
| 700 | 1 | |a Anwar, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Dominitz, Jason A |e verfasserin |4 aut | |
| 700 | 1 | |a Rogal, Shari S |e verfasserin |4 aut | |
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