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.