2036. Organizational Factors Predict Adherence to Diabetes Performance Measures: A National Survey
BJ BootsMiller, REAP, Iowa City Veterans Affairs Medical Center, KD McCoy, REAP, Iowa City Veterans Affairs Medical Center, TE Vaughn, Department of Health Management and Policy, The University of Iowa College of Public Health, SD Flach, REAP, Iowa City Veterans Affairs Medical Center and Department of Internal Medicine, The University of Iowa College of Medicine, BN Doebbeling, REAP, Iowa City Veterans Affairs Medical Center Department of Internal Medicine, The University of Iowa College of Medicine

Objectives: VA has developed performance measures to improve quality of care, tied to clinical practice guidelines (CPGs), as measured by External Peer Review (EPRP) chart audits. Decisions concerning how to implement CPGs in VA are made locally, and considerable variation in actual implementation exists. Performance measure adherence is one way to gauge progress in implementing CPGs. The purpose of this study is to identify organizational factors that influence adherence to EPRP diabetic performance measures.

Methods: We conducted a national survey of VA physicians, physician assistants, nurses and nurse practitioners regarding CPG implementation (interim N = 2,427 responded, 57%).  Survey data was linked to 2001 EPRP diabetic performance data (N = 136).  Facility-level performance scores were calculated as the sum of facility ranks above the 50th and 75th percentiles for each of the 10 diabetes performance measures.  Ten observations per facility were required. Principal components analysis with varimax rotation was used to identify conceptually-related constructs from the survey.

Results: A 5-factor solution emerged. Cronbach alphas were calculated for the factor scales: Cooperative Culture = 0.91(7 items), Organizational Support  = 0.87 (7 items), Information Technology = 0.76 (5 items), Performance Feedback = 0.79 (3 items), Provider Support = 0.62 (4 items). Scales were evaluated as potential correlates of adherence to the EPRP diabetes performance measures using univariate linear regression. Two factors were significantly related to adherence with the diabetic guidelines:  cooperative culture (P = 0.03), and provider support (P = .05). Information technology (P = .09) approached significance.  In preliminary multivariate models cooperative culture was strongly associated with adherence.

Conclusions: Organizational factors that predicted adherence to the diabetes performance measures include the presence of a cooperative culture, and a sense of support for providers.  Information technology may also support adherence. Performance feedback and organizational support did not predict adherence.

Impact: To ensure provider adherence to diabetes performance measures, facilities should, at minimum, work to develop a cooperative institutional culture, and be supportive of providers.  Availability of information technology may also be important to adherence.