title: Implementing a user-driven online quality improvement toolkit for cancer care.
abstract: OBJECTIVE
  Peer-to-peer collaboration within integrated health systems requires a mechanism for sharing quality improvement lessons. The Veterans Health Administration (VA) developed online compendia of tools linked to specific cancer quality indicators. We evaluated awareness and use of the toolkits, variation across facilities, impact of social marketing, and factors influencing toolkit use.
  
  
  METHODS
  A diffusion of innovations conceptual framework guided the collection of user activity data from the Toolkit Series SharePoint site and an online survey of potential Lung Cancer Care Toolkit users.
  
  
  RESULTS
  The VA Toolkit Series site had 5,088 unique visitors in its first 22 months; 5% of users accounted for 40% of page views. Social marketing communications were correlated with site usage. Of survey respondents (n = 355), 54% had visited the site, of whom 24% downloaded at least one tool. Respondents' awareness of the lung cancer quality performance of their facility, and facility participation in quality improvement collaboratives, were positively associated with Toolkit Series site use. Facility-level lung cancer tool implementation varied widely across tool types.
  
  
  CONCLUSIONS
  The VA Toolkit Series achieved widespread use and a high degree of user engagement, although use varied widely across facilities. The most active users were aware of and active in cancer care quality improvement. Toolkit use seemed to be reinforced by other quality improvement activities. A combination of user-driven tool creation and centralized toolkit development seemed to be effective for leveraging health information technology to spread disease-specific quality improvement tools within an integrated health care system.
authors: Oregon State University, Corvallis, OR; Veterans Administration (VA) Greater Los Angeles Healthcare System, Los Angeles; VA Palo Alto Health Care System; and Stanford University, Palo Alto, CA jeff.luck@oregonstate.edu.
authors: Jeff
authors: J
authors: Luck
authors: Oregon State University, Corvallis, OR; Veterans Administration (VA) Greater Los Angeles Healthcare System, Los Angeles; VA Palo Alto Health Care System; and Stanford University, Palo Alto, CA.
authors: Laura S
authors: LS
authors: York
authors: Oregon State University, Corvallis, OR; Veterans Administration (VA) Greater Los Angeles Healthcare System, Los Angeles; VA Palo Alto Health Care System; and Stanford University, Palo Alto, CA.
authors: Candice
authors: C
authors: Bowman
authors: Oregon State University, Corvallis, OR; Veterans Administration (VA) Greater Los Angeles Healthcare System, Los Angeles; VA Palo Alto Health Care System; and Stanford University, Palo Alto, CA.
authors: Randall C
authors: RC
authors: Gale
authors: Oregon State University, Corvallis, OR; Veterans Administration (VA) Greater Los Angeles Healthcare System, Los Angeles; VA Palo Alto Health Care System; and Stanford University, Palo Alto, CA.
authors: Nina
authors: N
authors: Smith
authors: Oregon State University, Corvallis, OR; Veterans Administration (VA) Greater Los Angeles Healthcare System, Los Angeles; VA Palo Alto Health Care System; and Stanford University, Palo Alto, CA.
authors: Steven M
authors: SM
authors: Asch
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D001364:Awareness; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D004059:Diffusion of Innovation; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation / Q000592:standards*; D006801:Humans; D020407:Internet; D008175:Lung Neoplasms / Q000175:diagnosis / Q000628:therapy*; D008389:Marketing of Health Services; D008495:Medical Oncology / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D015397:Program Evaluation; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D040241:Social Marketing; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs