Organizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration.
Dig Dis Sci
; 69(6): 2008-2017, 2024 Jun.
Article
in En
| MEDLINE
| ID: mdl-38616215
ABSTRACT
BACKGROUND:
The Veterans Health Administration provides care to more than 100,000 Veterans with cirrhosis.AIMS:
This implementation evaluation aimed to understand organizational resources and barriers associated with cirrhosis care.METHODS:
Clinicians across 145 Department of Veterans Affairs (VA) medical centers (VAMCs) were surveyed in 2022 about implementing guideline-concordant cirrhosis care. VA Corporate Data Warehouse data were used to assess VAMC performance on two national cirrhosis qualitymeasures:
HCC surveillance and esophageal variceal surveillance or treatment (EVST). Organizational factors associated with higher performance were identified using linear regression models.RESULTS:
Responding VAMCs (n = 124, 86%) ranged in resource availability, perceived barriers, and care processes. In multivariable models, factors independently associated with HCC surveillance included on-site interventional radiology and identifying patients overdue for surveillance using a national cirrhosis population management tool ("dashboard"). EVST was significantly associated with dashboard use and on-site gastroenterology services. For larger VAMCs, the average HCC surveillance rate was similar between VAMCs using vs. not using the dashboard (47% vs. 41%), while for smaller and less resourced VAMCs, dashboard use resulted in a 13% rate difference (46% vs. 33%). Likewise, higher EVST rates were more strongly associated with dashboard use in smaller (55% vs. 50%) compared to larger (57% vs. 55%) VAMCs.CONCLUSIONS:
Resources, barriers, and care processes varied across diverse VAMCs. Smaller VAMCs without specialty care achieved HCC and EVST surveillance rates nearly as high as more complex and resourced VAMCs if they used a population management tool to identify the patients due for cirrhosis care.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
United States Department of Veterans Affairs
/
Liver Cirrhosis
Limits:
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
Dig Dis Sci
Year:
2024
Type:
Article
Affiliation country:
United States