Association between facility characteristics and the process of care delivered to patients with hepatitis C virus infection.
BACKGROUND
Available data suggest problems in the process of care provided to patients with chronic hepatitis C (HCV). However, the solutions to these problems are less obvious. Healthcare facility factors are potentially modifiable and may enhance process quality in HCV treatment.


METHODS
We evaluated the relationship between the process of HCV care and facility factors including number of weekly half-day HCV clinics per 1,000 HCV patients, HCV-specific quality-improvement initiatives, and administrative service of the HCV clinic (gastroenterology, infectious disease, primary care) for a cohort of 34,258 patients who sought care in 126 Veterans Affairs facilities during 2003-2006. We measured HCV care on the basis of 23 HCV-specific process measures capturing pretreatment (seven measures), preventive and/or comorbid (seven measures), and treatment and treatment monitoring care (nine measures).


RESULTS
Patients seen at a facility with >8 half-day clinics were 52 % more likely to receive overall indicated care (OR 1.52, 95 % CI 1.13-2.05). Patients seen at a facility with >3 HCV quality improvement initiatives were more likely to receive better preventive and/or comorbid care (OR 1.32, 95 % CI 1.00-1.74). Compared with patients in facilities with no dedicated HCV clinic, patients at facilities with gastroenterology-based clinics received better pretreatment care (OR 1.36, 95 % CI 1.01-1.85) and more antiviral treatment (OR 1.45, 95 % CI 1.06-1.97) whereas those at facilities with infectious disease-based or primary care-based clinics received better preventive and/or comorbid care (OR 1.59, 95 % CI 1.06-2.39 and 1.84, 95 % CI 1.21-2.79 respectively).


CONCLUSIONS
Several facility factors affected the process of HCV care. These factors may serve as targets for quality-improvement efforts.
Houston VA HSR&D Center of Excellence, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA, fasiha.kanwal@va.gov.
Fasiha
F
Kanwal
Tuyen
T
Hoang
Timothy
T
Chrusciel
Jennifer R
JR
Kramer
Hashem B
HB
El-Serag
Janet
J
Durfee
Jason A
JA
Dominitz
Elizabeth M
EM
Yano
Steven M
SM
Asch
D000554:Ambulatory Care Facilities / Q000592:standards; D000998:Antiviral Agents / Q000627:therapeutic use*; D001071:Appointments and Schedules; D015897:Comorbidity; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D005762:Gastroenterology / Q000592:standards; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D055552:Infectious Disease Medicine / Q000592:standards; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000592:standards; D011314:Preventive Health Services; D011320:Primary Health Care; D058996:Quality Improvement; D011787:Quality of Health Care / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs
D000998:Antiviral Agents