EM Yano, VA Greater Los Angeles HSR&D Center of Excellence; WB Weeks, White River Junction VA Medical Center; LV Rubenstein, VA Greater Los Angeles HSR&D Center of Excellence

Workshop Objectives: The purpose of this workshop is to provide a conceptual framework for translating health services research findings into changes in practice and policy at the facility level, building on the Institute for Healthcare Improvement's (IHI) Idealized Clinical Practice model. This workshop is designed to provide an overview of the state of VA primary care delivery and managed care arrangements nationwide based on the 1999 VHA Survey of Primary Care Practices. The workshop is designed to provide health services researchers with insights into the organization and features of VA care delivery systems that are likely to foster or hinder adoption of best practices.

Workshop Activities: Workshop leaders will provide an overview of the Institute for Healthcare Improvement (IHI) Idealized Clinical Practice model currently underway and being evaluated in 40 geographically diverse community-based ambulatory care practices. The Idealized Clinical Practice is grounded on four thematic bases: access, interaction, reliability, and vitality. Exemplars for each of these themes will be presented, followed by an overview of the results of the 1999 VHA Survey of Primary Care Practices in relation to an idealized model of VA practice. An entity survey of all primary care directors of VA facilities with 4,000 or more patients (n=219, 93% response rate), the VHA Survey of Primary Care Practices builds on two prior all-VA surveys (1993 and 1996). Results reflect the significant changes in organization that VA facilities have undergone and demonstrate the importance of evaluating the context within which health services research activities occur. Guidelines for facilitating the conduct and dissemination of effectiveness research, guideline implementation studies, and other practice-based interventions will be discussed based on case examples from multi-site trials and structure-outcome models (e.g., site selection criteria, leadership/authority for assigning resources to practice changes, etc.).

Target Audience: This workshop is designed for clinician and non-clinician health services researchers with an interest in VA primary and ambulatory care delivery, the level and extent of VA adoption of managed care practices, and the subsequent implications for planned and ongoing HSR&D projects in organizational research, effectiveness studies and structural issues in dissemination of best practices in VA health care facilities.

Audience Familiarity: This workshop assumes general familiarity with the VA health care system and ambulatory care delivery.