Address correspondence to Sylvia J. Hysong, Ph.D., Houston Center for Quality of Care & Utilization Studies, Baylor College of Medicine, Michael E. DeBakey VA Medical Center (152), 2002 Holcombe Blvd., Houston, TX 77030. Richard G. Best, Ph.D., is with Healthcare Solutions, Lockheed Martin Information Technology, Alexandria, VA. Jacqueline A. Pugh, M.D., is with the South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, TX.
Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics
Article first published online: 17 AUG 2006
Health Services Research
Volume 42, Issue 1p1, pages 84–103, February 2007
How to Cite
Hysong, S. J., Best, R. G. and Pugh, J. A. (2007), Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics. Health Services Research, 42: 84–103. doi: 10.1111/j.1475-6773.2006.00610.x
- Issue published online: 17 AUG 2006
- Article first published online: 17 AUG 2006
- qualitative research;
- implementation research;
- evidence based medicine;
- health services research
Background. The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success.
Objective. This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA.
Research Design. Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs.
Subjects. One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic.
Measures. Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews.
Findings. High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices.
Conclusion. A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels.