title: Early adoption of human immunodeficiency virus quality improvement in Veterans Affairs medical centers: use of organizational surveys to measure readiness to change and adapt interventions to local priorities.
abstract: Potential delivery system responsiveness to quality improvement (QI) interventions is rarely assessed before implementation, although it might aid in interventional design. Preparing for a national initiative, we assessed Veterans Affairs (VA) human immunodeficiency virus (HIV) clinic organizational characteristics and attitudes toward QI interventions. Current QI activities and attitudes toward potential effectiveness of several techniques to improve antiretroviral and opportunistic infection prophylaxis therapy were assessed. These included computerized clinical reminders (CRs), group-based QI, expert advice, and facility and provider-level audit/feedback. Organizational characteristics were also examined. Respondents rated CRs and group-based QI (GBQI) interventions most highly. Western and complex facilities viewed CR and GBQI interventions more positively than less complex facilities or those in other regions, even controlling for organizational characteristics and perceived barriers to change. VA clinicians favored CR and GBQI over facility/ provider feedback. The persistence of regional variation should be further explored. Organizational surveys of attitudes toward potential QI interventions can assist in choosing interventions and targeting specific facilities.
authors.affiliation: VA Greater Los Angeles HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, USA. henry.anaya@med.va.gov
authors.forename: Henry D
authors.initials: HD
authors.lastname: Anaya
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004059:Diffusion of Innovation; D019983:Guideline Adherence; D015658:HIV Infections / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006292:Health Priorities; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D016015:Logistic Models; D008330:Management Audit / Q000458:organization & administration*; D008960:Models, Psychological; D020380:Needs Assessment / Q000458:organization & administration; D016017:Odds Ratio; D015279:Organizational Culture; D009936:Organizational Innovation; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D013997:Time Factors; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration