scholarly journals Use of A Community of Practice For The Implementation of Evidence-Based Practices For Heart Failure Within The United States Department of Veterans Affairs

2021 ◽  
Author(s):  
Anju Sahay ◽  
Paul A. Heidenreich ◽  
Brian S Mittman ◽  
Parisa Gholami ◽  
Shoutzu Lin
Keyword(s):  
United States ◽  
Heart Failure ◽  
Quality Of Care ◽  
The United States ◽  
Veterans Affairs ◽  
Evidence Based ◽  
Department Of Veterans Affairs ◽  
Clinical Practices ◽  
Evidence Based Practices

Abstract Communities of Practice (CoPs) are a promising approach to facilitate the implementation of evidence-based practices (EBPs) to improve care for chronic conditions like heart failure (HF). COPs involve a complex process of acquiring and converting both explicit and tacit knowledge into clinical activities. Formation: In July 2006, a CoP called the Heart Failure Provider Network (HF Network) was established in the United States (US) Department of Veterans Affairs (VA) with the overarching goal of improving the quality of care for HF patients. The CoP has involved a total of 1,341 multidisciplinary and multilevel members at all 144 VA Health Care Systems (sites). Examples of CoP activities include discussions of interventions to decrease hospitalization rates and to empower patients and caregivers for self-management. Goals of the CoP include networking facilitation, information dissemination and exchange, collaboration and implementation of EBPs. Assessment: We conceptualized the assessment (formative evaluation) of the HF Network in terms of its various activities (inputs) and proximal impacts (mediators) at the individual-level, and its distal and ultimate impacts (outcomes) at the site-level leading to an improved culture of implementation of new/improved EBPs at the system-wide level. The HF Network membership grew steadily over the nine years. Most members were practicing clinicians (n = 891, 66.4%), followed by administrators (n = 342, 25.5%), researchers (n = 70, 5.2%), and others (n = 38, 2.8%). Participation was “active” for 70.9% versus “passive” for 29.4% of members. The distribution of active members (clinicians 64.7%, administrators 21.6%) was similar to the distribution of overall membership. Survey respondents perceived the HF Network as useful in terms of its varied activities and resources relevant for patient care. Members, particularly those that consider themselves influential in improving quality of care, noted multiple benefits of membership. These included confirmation of one’s own clinical practices, evidence-based changes to their practice and help in understanding facilitators and barriers in setting up or running HF clinics and other programs.

Who gets coached? A qualitative inquiry into community clinicians’ decisions to use caregiver coaching

Autism ◽  
2021 ◽  
pp. 136236132110594
Author(s):  
Liza Tomczuk ◽  
Rebecca E Stewart ◽  
Rinad S Beidas ◽  
David S Mandell ◽  
Melanie Pellecchia
Keyword(s):  
United States ◽  
Early Intervention ◽  
The United States ◽  
Evidence Based ◽  
Autistic Children ◽  
Evidence Based Practices ◽  
Quality Of Evidence ◽  
Marginalized Groups ◽  
Vulnerable Families

Clinicians’ beliefs about an intervention’s fit with an individual family influence whether they use it with that family. The factors that influence clinicians’ decisions to implement evidence-based practices for young autistic children have yet to be evaluated systematically. These factors may partially account for the significant disparities in quality of and access to early intervention. We examined disparities in clinicians’ reported use of caregiver coaching, an evidence-based practice, with families from minoritized or structurally marginalized groups, and the perceived reasons for those disparities, to assess the factors that influence clinicians’ use of caregiver coaching. We conducted semi-structured interviews with 36 early intervention clinicians from publicly funded early intervention agencies in two distinct geographic regions in the United States. Clinicians identified social and structural factors, including perceived family characteristics and stigma, that influenced their beliefs about the fit of coaching with families from minoritized or structurally marginalized groups. These findings point to the presence of beliefs that likely exacerbate disparities in access to evidence-based practices and reduce the quality of care for minoritized families of young autistic children. These findings highlight the need to develop and deploy equity-focused implementation strategies to improve both access to and quality of evidence-based practices for young autistic children from minoritized groups. Lay abstract Providers’ beliefs about an intervention’s fit with a family can affect whether or not they use that intervention with a family. The factors that affect providers’ decisions to use evidence-based practices for young autistic children have not been studied. These factors may play a role in the major differences we see in the quality of and access to early intervention services in the community. We looked at differences in providers’ use of caregiver coaching, an evidence-based practice, with families from minority or vulnerable backgrounds, and the possible reasons for those differences. We did this to figure out what factors affect providers’ use of caregiver coaching. We interviewed 36 early intervention providers from early intervention agencies in two different parts of the United States. Providers pointed out things like what they thought about a family’s circumstances that affected their beliefs about how well coaching fits with minority and vulnerable families. Our findings bring attention to these beliefs that likely make accessing evidence-based practices for minority and vulnerable families harder and lessen the quality of care for these families of young autistic children. These findings highlight the need to come up with and use strategies to improve both access to and the quality of evidence-based practices for young autistic children from minority and vulnerable groups.

scholarly journals Quality of Care and Outcomes of Older Patients With Heart Failure Hospitalized in the United States and Canada

2005 ◽  
Vol 165 (21) ◽  
pp. 2486 ◽  
Author(s):  
Dennis T. Ko ◽  
Jack V. Tu ◽  
Frederick A. Masoudi ◽  
Yongfei Wang ◽  
Edward P. Havranek ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Quality Of Care ◽  
Older Patients ◽  
The United States ◽  
Patients With Heart Failure

scholarly journals Regional Variations in Heart Failure Quality and Outcomes: Get With The Guidelines–Heart Failure Registry

2021 ◽  
Author(s):  
Luke C. Cunningham ◽  
Gregg C. Fonarow ◽  
Clyde W. Yancy ◽  
Shubin Sheng ◽  
Roland A. Matsouaka ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Patient Characteristics ◽  
The United States ◽  
Short Term ◽  
Quality And Outcomes ◽  
Get With The Guidelines

Background Regional patient characteristics, care quality, and outcomes may differ based on a variety of factors among patients hospitalized for heart failure (HF). Regional disparities in outcomes of cardiovascular disease have been suggested across various regions in the United States. This study examined whether there are significant differences by region in quality of care and short‐term outcomes of hospitalized patients with HF across the United States. Methods and Results We examined regional demographics, quality measures, and short‐term outcomes across 4 US Census Bureau regions in patients hospitalized with HF and enrolled in the GWTG‐HF (Get With The Guidelines–Heart Failure) registry from 2010 to 2016. Differences in length of stay and mortality by region were examined with multivariable logistic regression. The study included 423 333 patients hospitalized for HF in 488 hospitals. Patients in the Northeast were significantly older. Completion of achievement measures, with few exceptions, were met with similar frequency across regions. Multivariable analysis demonstrated significantly lower in‐hospital mortality in the Midwest compared with the Northeast (hazard ratio, 0.64; 95% CI, 0.51–0.8; P <0.00001). The length of stay varied significantly by region with a significantly higher risk‐adjusted length of stay in the Northeast compared with other regions. Conclusions Although we did not find any substantial differences by region in quality of care in patients hospitalized for HF, risk‐adjusted inpatient mortality was found to be lower in the Midwest compared with the Northeast, and may be secondary to unmeasured differences in patient characteristics, and to longer length of stay in the Northeast.

Transformation of the US Veterans Health Administration

2006 ◽  
Vol 1 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Jonathan B. Perlin
Keyword(s):  
United States ◽  
Health Care ◽  
Veterans Health Administration ◽  
The United States ◽  
Veterans Affairs ◽  
United States Department ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
The Us

Ten years ago, it would have been hard to imagine the publication of an issue of a scholarly journal dedicated to applying lessons from the transformation of the United States Department of Veterans Affairs Health System to the renewal of other countries' national health systems. Yet, with the recent publication of a dedicated edition of the Canadian journal Healthcare Papers (2005), this actually happened. Veterans Affairs health care also has been similarly lauded this past year in the lay press, being described as ‘the best care anywhere’ in the Washington Monthly, and described as ‘top-notch healthcare’ in US News and World Report's annual health care issue enumerating the ‘Top 100 Hospitals’ in the United States (Longman, 2005; Gearon, 2005).

Abstract 282: Assessing Levels of Active Participation through a VA Provider Network to Improve Quality of Care for Veterans with Heart Failure

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Anju Sahay ◽  
Paul Heidenreich
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Active Participation ◽  
Teaching Hospitals ◽  
Evidence Based Practices ◽  
Provider Network ◽  
Participation Level ◽  
Level Data ◽  
Facility Level

Objective: The goal of the Dept. of Veterans Affairs (VA) Chronic Heart Failure (CHF) QUERI program is to improve the quality of care for heart failure (HF) patients and implement evidence-based practices throughout the VA system. One strategy to achieve this goal was to create a VA heart failure provider Network which occurred in 2006. We sought to characterize provider participation in this mature network. Method: We tracked all members of the HF Network including their title, location at one of 144 VA facilities; date joined and if applicable, date left the HF Network. We considered the following activities to be evidence of “active” participation: attended a web-based meeting or the annual in-person meeting, requested meeting materials, or completed a periodic survey of providers. Participation of all other members is considered “passive”. For this project we assessed each facility’s level of participation in the HF Network from July 2006 till June 2013 (7 years). Facility participation level was characterized as “None” (no member at that facility with active participation), “Low” (at least one member at that facility attended 1-2 activities) and “High” (at least one member at that facility participated in ≥3 activities). Data were linked to existing facility-level data that included presence of an HF clinic, cardiac cath lab, use of pharmacist, bed size, membership in Council on Teaching Hospitals (COTH), and presence of an Accredited Graduate Medical Education (ACGME) program. Results: Altogether, 1205 providers have participated in the HF Network. As of June 2013, 987 providers from 144 VA facilities participate in this network. They include VACO leadership (1%), VISN leadership (4%), facility leadership (9%), Chiefs of Cardiology (7%), staff physicians (32%), nurses (28%), pharmacists (5%) and others (14%). Participation at the facility-level has increased from 2008 (None=37, Low=43 and High=64) to 2013 (None=8, Low=16 and High=120, (p <0.001). High participating facilities were more likely to be classified as tertiary (p <.016), COTH members (p <0.001), having ACGME programs (p <0.001), and located in the West or Southeast United States (p =.03). High participating facilities are also more likely to have a HF clinic (p <0.001), a cardiac catheterization lab (<0.001), and use a pharmacist in routine HF care (p <.03). Conclusions: Involvement and active participation in the VA HF Network has grown and is more likely at academic facilities and those providing more intensive services.

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