Organizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration.

Autor: McCurdy H; Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA., Nobbe A; Digestive Diseases Section, Cincinnati VA Medical Center, Cincinnati, OH, USA., Scott D; VA Central Texas Healthcare System, Temple, TX, USA., Patton H; VA San Diego Healthcare System, San Diego, CA, USA.; University of California San Diego, La Jolla, CA, USA., Morgan TR; VA Long Beach Healthcare System, Long Beach, CA, USA.; Department of Medicine, University of California, Irvine, CA, USA.; National Gastroenterology and Hepatology Program, Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA., Bajaj JS; Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA.; Division of Gastroenterology, Hepatology and Nutrition, Central Virginia VA Health Care System, Richmond, VA, USA., Yakovchenko V; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA., Merante M; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA., Gibson S; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Lamorte C; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA., Baffy G; Section of Gastroenterology, Department of Medicine, VA Boston Healthcare System, Boston, MA, USA.; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Ioannou GN; VA Puget Sound Health Care System, Seattle, WA, USA.; University of Washington, Seattle, WA, USA., Taddei TH; VA Connecticut Healthcare System, West Haven, CT, USA.; Yale University, New Haven, CT, USA., Rozenberg-Ben-Dror K; VISN 12 PBM, VA Great Lakes Health Care System, Westchester, IL, USA., Anwar J; VA Long Beach Healthcare System, Long Beach, CA, USA.; National Gastroenterology and Hepatology Program, Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA., Dominitz JA; National Gastroenterology and Hepatology Program, Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA.; VA Puget Sound Health Care System, Seattle, WA, USA.; University of Washington, Seattle, WA, USA., Rogal SS; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. rogalss@upmc.edu.; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. rogalss@upmc.edu.; Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA. rogalss@upmc.edu.; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30 Room 2A113, University Drive (151C), Pittsburgh, PA, 15240, USA. rogalss@upmc.edu.
Jazyk: angličtina
Zdroj: Digestive diseases and sciences [Dig Dis Sci] 2024 Jun; Vol. 69 (6), pp. 2008-2017. Date of Electronic Publication: 2024 Apr 14.
DOI: 10.1007/s10620-024-08409-6
Abstrakt: 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.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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