Provider adherence to COPD guidelines: relationship to organizational factors.
OBJECTIVE
A clinical practice guideline for chronic obstructive pulmonary disease (COPD) was implemented in all Veterans Health Administration (VHA) hospitals in the US. The aim of the current analyses is to describe current adherence rates and the organizational factors related to provider adherence to the COPD guideline.


METHODS
We administered a survey to key informants that assessed adherence to the COPD guideline, approaches to disseminating and implementing the COPD guideline, providers' views of the COPD guideline and guidelines in general, and attitudes about the organizational climate.


RESULTS
Surveys were returned by 242 key informants (58%) at 130 of the 143 VHA hospitals (91%). Adherence to the COPD clinical practice guideline is perceived by quality managers within the VHA to be good. The final multivariable predictor model identified five measures that were related to provider adherence with the COPD guideline (R(2) = 0.43): responsibilities were changed to support adherence to the COPD guideline, physicians believe that guidelines implemented in the past year were applicable to their practice, patient care providers consistently participate in activities to improve the quality of care, the regional network office monitors the pace at which guidelines are implemented, and there is a system to provide feedback on routinely collected guideline adherence data collected in addition to External Peer Review Program data.


CONCLUSIONS
Organizations can play an important role in providing a supportive climate to facilitate their providers' adherence to guidelines by implementing processes and culture changes that involve these five measures.
Ward
Marcia M
MM
Department of Health Management and Policy, University of Iowa, Iowa City, IA 52242-1008, USA. marcia-m-ward@uiowa.edu
Yankey
Jon W
JW
Vaughn
Thomas E
TE
BootsMiller
Bonnie J
BJ
Flach
Stephen D
SD
Watrin
Shea
S
Doebbeling
Bradley N
BN
D003625:Data Collection; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D015279:Organizational Culture; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D014481:United States