RESUMO
PURPOSE: 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. CONCLUSION: 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.
Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Implementação de Plano de Saúde/normas , Internet , Neoplasias Pulmonares/terapia , Oncologia/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Conscientização , Difusão de Inovações , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Neoplasias Pulmonares/diagnóstico , Marketing de Serviços de Saúde , Padrões de Prática Médica/normas , Avaliação de Programas e Projetos de Saúde , Marketing Social , Resultado do Tratamento , Estados Unidos , United States Department of Veterans AffairsAssuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Neoplasias Pulmonares/terapia , Melhoria de Qualidade/organização & administração , United States Department of Veterans Affairs/organização & administração , Redes de Comunicação de Computadores , Humanos , Inovação Organizacional , Projetos Piloto , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estados UnidosRESUMO
Collaborative care models for depression in primary care are effective and cost-effective, but difficult to spread to new sites. Translating Initiatives for Depression into Effective Solutions (TIDES) is an initiative to promote evidence-based collaborative care in the U.S. Veterans Health Administration (VHA). Social marketing applies marketing techniques to promote positive behavior change. Described in this paper, TIDES used a social marketing approach to foster national spread of collaborative care models. TIDES SOCIAL MARKETING APPROACH: The approach relied on a sequential model of behavior change and explicit attention to audience segmentation. Segments included VHA national leadership, Veterans Integrated Service Network (VISN) regional leadership, facility managers, frontline providers, and veterans. TIDES communications, materials and messages targeted each segment, guided by an overall marketing plan. RESULTS: Depression collaborative care based on the TIDES model was adopted by VHA as part of the new Primary Care Mental Health Initiative and associated policies. It is currently in use in more than 50 primary care practices across the United States, and continues to spread, suggesting success for its social marketing-based dissemination strategy. DISCUSSION AND CONCLUSION: Development, execution and evaluation of the TIDES marketing effort shows that social marketing is a promising approach for promoting implementation of evidence-based interventions in integrated healthcare systems.