Informatics implementation in the Veterans Health Administration (VHA) healthcare system to improve quality of care.
We describe VHA's information technology (IT) implementation from the providers' perspective, and identify factors influencing its effective implementation to improve care. We surveyed a stratified random national sample of 4227 clinicians from three VHA primary care provider groups: 1) physicians; 2) nurse practitioners, physician assistants; and 3) nurses. Facility-level IT support availability was rated across six dimensions: 1) access to literature/evidence, 2) computerized decision support, 3) computerized clinical data, 4) error reduction, 5) provider communication, and 6) patient communication. Factor analysis identified a 5-item scale (IT clinical support, á = 0.76). Generalized estimating equation models identified factors influencing IT clinical support. Complete data from 123 hospitals (1777 providers) were included. IT clinical support was higher in urban hospitals (p<0.05) and those with cooperative cultures (p<0.01). Opportunities exist to enhance effective use of IT to support clinical decision making, electronic communication with patients and access to recommendations while delivering care.
Doebbeling
Bradley N
BN
VA HSR&/D Center on Implementing Evidence-based Practice, Roudebush, VAMC, Indianapolis, IN, USA.
Vaughn
Thomas E
TE
McCoy
Kimberly D
KD
Glassman
Peter
P
D019033:Delivery of Health Care, Integrated; D005163:Factor Analysis, Statistical; D019538:Health Care Surveys; D006787:Hospitals, Veterans / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007256:Information Systems / Q000706:statistics & numerical data; D016347:Medical Records Systems, Computerized; D015279:Organizational Culture; D009936:Organizational Innovation; D010564:Personnel, Hospital; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D014481:United States; D014493:United States Department of Veterans Affairs