Organizational Characteristics of High- and Low-Performing Anticoagulation Clinics in the Veterans Health Administration
Article first published online: 2 FEB 2012
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 4, pages 1541–1560, August 2012
How to Cite
Rose, A. J., Petrakis, B. A., Callahan, P., Mambourg, S., Patel, D., Hylek, E. M. and Bokhour, B. G. (2012), Organizational Characteristics of High- and Low-Performing Anticoagulation Clinics in the Veterans Health Administration. Health Services Research, 47: 1541–1560. doi: 10.1111/j.1475-6773.2011.01377.x
- Issue published online: 5 JUL 2012
- Article first published online: 2 FEB 2012
- VA Stroke Quality Enhancement Research Initiative (QUERI). Grant Number: RRP-10-054
- VA HSR&D Career Development Award. Grant Number: CDA-2-08-017
- Qualitative research;
- quality of health care;
- organization and administration
Anticoagulation clinics (ACCs) can improve anticoagulation control and prevent adverse events. However, ACCs vary widely in their performance on anticoagulation control. Our objective was to compare the organization and management of top-performing with that of bottom-performing ACCs.
Data Sources/Study Setting
Three high outlier and three low outlier ACCs in the Veterans Health Administration (VA).
Site visits with qualitative data collection and analysis.
Data Collection/Extraction Methods
We conducted semi-structured interviews with ACC staff regarding work flow, staffing, organization, and quality assurance efforts. We also observed ACC operations and collected documents, such as the clinic protocol. We used grounded thematic analysis to examine site-level factors associated with high and low outlier status.
High outlier sites were characterized by (1) adequate (pharmacist) staffing and effective use of (nonpharmacist) support personnel; (2) innovation to standardize clinical practice around evidence-based guidelines; (3) the presence of a quality champion for the ACC; (4) higher staff qualifications; (5) a climate of ongoing group learning; and (6) internal efforts to measure performance. Although high outliers had all of these features, no low outlier had more than two of them.
The top-performing ACCs in the VA system shared six relatively recognizable characteristics. Efforts to improve performance should focus on these domains.