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- Title
Organizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration.
- Authors
McCurdy, Heather; Nobbe, Anna; Scott, Dawn; Patton, Heather; Morgan, Timothy R.; Bajaj, Jasmohan S.; Yakovchenko, Vera; Merante, Monica; Gibson, Sandra; Lamorte, Carolyn; Baffy, Gyorgy; Ioannou, George N.; Taddei, Tamar H.; Rozenberg-Ben-Dror, Karine; Anwar, Jennifer; Dominitz, Jason A.; Rogal, Shari S.
- 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 quality measures: 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.
- Subjects
UNITED States. Veterans Health Administration; UNITED States. Dept. of Veterans Affairs; CIRRHOSIS of the liver; DATA warehousing; VETERANS' health; INTERVENTIONAL radiology; ESOPHAGECTOMY
- Publication
Digestive Diseases & Sciences, 2024, Vol 69, Issue 6, p2008
- ISSN
0163-2116
- Publication type
Article
- DOI
10.1007/s10620-024-08409-6