2041. VA Diabetes
Hypertension Guideline Implementation Strategies
CP Kowalski, Ann Arbor VA HSR&D, JC Lowery, Ann Arbor VA
HSR&D, L Wyszewianski, University of Michigan, LA Green,
University of Michigan
Objectives: Although
educational and simple dissemination strategies are the approach most often
favored for implementing practice guidelines, these approaches seldom result in
lasting practice changes. Previous research has shown that multi-faceted
approaches tend to have more positive effects. What kinds of approaches are used
in VA medical centers? The objective of this VA HSR&D-funded study was to
determine what strategies have been implemented in VA medical centers for
meeting diabetes hypertension guidelines, as the first phase in a larger study
to determine which strategies are most effective.
Methods: Eighty-six
semi-structured telephone interviews with an average length of 38 minutes were
conducted with two of the following individuals at each of 43 participating
VAMCs: Chief of Staff, Chief of
Medicine, Associate Chief of Staff for Ambulatory Care, Quality Manager,
Director of Primary Care, and attending physicians. The purpose of these interviews was to determine what
strategies were implemented for meeting diabetes hypertension guidelines from
1999 through 2001.
Results: All of the sites
chose to implement some type of educational intervention, whether written (41
sites) or a presentation or conference (37 sites). Thirty-four sites (79%)
implemented some type of reminder system for hypertension. Forty sites (93%)
provided group feedback and 39 sites (91%) provided individual physician
feedback on hypertension. Seven facilities (16%) initiated monetary incentives
in the form of cash awards ranging from $200 to $3,000 for outstanding
performance on the guidelines and VA performance measures. Twelve sites (28%)
identified local barriers (e.g., limited time, staffing, and computers) to
implementing hypertension guidelines and worked to remove those. Five sites
(12%) instituted penalties for non-compliance with VA goals and guidelines.
Conclusions: Unfortunately,
the most common strategies used by VA medical centers—traditional continuing
education and simple dissemination—have been shown in previous research to be
ineffective in guideline implementation. Instead,
organizational, motivational, and multi-faceted interventions tend to be more
effective at changing behaviors. More medical centers could benefit from implementing
innovative ideas from other sites, such as monetary incentives, penalties, and
barrier removal.
Impact: The interview results provide specific examples of multi-faceted approaches for translating research into practice.