| |
In FY15 did your center use any of these infrastructure changes to promote HCV care in your center?
| | | |
|
1
|
Change physical structure and equipment (e.g., purchase a FibroScan, expand clinic space, open new clinics)
|
42 (53)
|
0.36
|
<0.01
|
|
2
|
Change the record systems (e.g., locally create new or update to national clinical reminder in CPRS, develop standardized note templates)
|
57 (71)
|
−0.02
|
0.89
|
|
3
|
Change the location of clinical service sites (e.g., extend HCV care to the CBOCs)
|
21 (26)
|
0.36
|
<0.01
|
|
4
|
Develop a separate organization or group responsible for disseminating HCV care (outside of the HIT Collaborative)
|
18 (23)
|
0.21
|
0.07
|
|
5
|
Mandate changes to HCV care (e.g., when you changed to the new HCV medications was this based on a leadership mandate?)
|
44 (55)
|
0.05
|
0.69
|
|
6
|
Create or change credentialing and/or licensure standards (e.g., change scopes of practice or service agreements)
|
23 (29)
|
0.01
|
0.92
|
|
7
|
Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation
|
3 (4)
|
0.23
|
0.04
|
|
8
|
Change accreditation or membership requirements
|
3 (4)
|
0.23
|
0.04
|
| |
In FY15 did your center use any of these financial strategies to promote HCV care in your center?
| | | |
|
9
|
Access new funding (This DOES NOT include funding from national VA for the medications, but should include receiving funds from the HIT Collaborative to your center)
|
24 (30)
|
0.20
|
0.08
|
|
10
|
Alter incentive/allowance structures
|
4 (5)
|
0.04
|
0.76
|
|
11
|
Provide financial disincentives for failure to implement or use the clinical innovations
|
0
|
.
|
.
|
|
12
|
Respond to proposals to deliver HCV care (e.g., submit a HIT proposal to obtain money for your center specifically)
|
35 (44)
|
0.19
|
0.11
|
|
13
|
Change billing (e.g., create new clinic codes for billing for HCV treatment or HCV education)
|
9 (11)
|
0.17
|
0.15
|
|
14
|
Place HCV medications on the formulary
|
56 (70)
|
−0.05
|
0.67
|
|
15
|
Alter patient fees
|
0
| | |
|
16
|
Use capitated payments
|
0
| | |
|
17
|
Use other payment schemes
|
4 (5)
|
0.22
|
0.06
|
|
18
|
Create new clinical teams (e.g., interdisciplinary clinical working groups)
|
37 (46)
|
0.25
|
0.04
|
|
19
|
Facilitate the relay of clinical data to providers (e.g., provide outcome data to providers)
|
45 (56)
|
0.20
|
0.09
|
|
20
|
Revise professional roles (e.g., allow the pharmacist to see and treat patients in the clinic)
|
57 (71)
|
0.24
|
0.04
|
|
21
|
Develop reminder systems for clinicians (e.g., use CPRS reminders)
|
27 (34)
|
−0.16
|
0.19
|
|
22
|
Develop resource sharing agreements (e.g., partner with the VERC, the HITs, or other organizations with the resources to help implement changes)
|
21 (26)
|
0.24
|
0.04
|
| |
In FY15 did your center employ any of these activities to provide interactive assistance to promote HCV care in your center?
| | | |
|
23
|
Use outside assistance often called “facilitation” (e.g., coaching, education, and/or feedback from the facilitator)
|
6 (8)
|
0.16
|
0.17
|
|
24
|
Have someone from inside the clinic or center (often called “local technical assistance”) tasked with assisting the clinic
|
12 (15)
|
0.38
|
<0.01
|
|
25
|
Provide clinical supervision (e.g., train providers)
|
35 (44)
|
0.29
|
0.01
|
|
26
|
Use a centralized system (i.e., from the VISN) to deliver facilitation
|
22 (28)
|
0.38
|
<0.01
|
| |
In FY15 did your center employ any of these activities to tailor HCV care in your center?
| | | |
|
27
|
Use data experts to manage HCV data (e.g., use the VERC, pharmacy benefits management, VISN, or CCR data experts to track patients or promote care)
|
46 (58)
|
0.18
|
0.12
|
|
28
|
Use data warehousing techniques (e.g., dashboard, clinical case registry, CDW)
|
68 (85)
|
0.15
|
0.19
|
|
29
|
Tailor strategies to deliver HCV care (i.e., alter HCV care to address barriers to care that you identified in your population using data you collected)
|
50 (63)
|
0.21
|
0.08
|
|
30
|
Promote adaptability (i.e., Identify the ways HCV care can be tailored to meet local needs and clarify which elements of care must be maintained to preserve fidelity)
|
44 (55)
|
0.16
|
0.17
|
| |
In FY15 did your center employ any of these activities to train or educate providers to promote HCV care in your center?
| | | |
|
31
|
Conduct educational meetings
|
41 (51)
|
0.24
|
0.05
|
|
32
|
Have an expert in HCV care meet with providers to educate them
|
33 (41)
|
0.34
|
<0.01
|
|
33
|
Provide ongoing HCV training
|
39 (49)
|
0.26
|
0.03
|
|
34
|
Facilitate the formation of groups of providers and fostered a collaborative learning environment
|
35 (44)
|
0.38
|
<0.01
|
|
35
|
Developed formal educational materials
|
31 (39)
|
0.00
|
0.97
|
|
36
|
Distribute educational materials (e.g., guidelines, manuals, or toolkits)
|
44 (55)
|
0.11
|
0.35
|
|
37
|
Provide ongoing consultation with one or more HCV treatment experts
|
46 (58)
|
0.11
|
0.37
|
|
38
|
Train designated clinicians to train others (e.g., primary care providers, SCAN-ECHO)
|
16 (20)
|
−0.07
|
0.56
|
|
39
|
Vary the information delivery methods to cater to different learning styles when presenting new information
|
29 (36)
|
0.29
|
0.02
|
|
40
|
Give providers opportunities to shadow other experts in HCV
|
26 (33)
|
0.12
|
0.32
|
|
41
|
Use educational institutions to train clinicians
|
9 (11)
|
0.21
|
0.07
|
| |
In FY15 did your center employ any of these activities to develop stakeholder interrelationships to promote HCV care in your center?
| | | |
|
42
|
Build a local coalition/team to address challenges
|
42 (53)
|
0.27
|
0.03
|
|
43
|
Conduct local consensus discussions (i.e., determine how to change things by having meetings with local leaders and providers)
|
38 (48)
|
0.42
|
<0.01
|
|
44
|
Obtain formal written commitments from key partners that state what they will do to implement HCV care (e.g., written agreements with CBOCS)
|
3 (4)
|
0.20
|
0.09
|
|
45
|
Recruit, designate, and/or train leaders
|
21 (26)
|
0.29
|
0.01
|
|
46
|
Inform local opinion leaders about advances in HCV care
|
39 (49)
|
0.33
|
<0.01
|
|
47
|
Share the knowledge gained from quality improvement efforts with other sites outside your medical center
|
30 (38)
|
0.32
|
<0.01
|
|
48
|
Identify and prepare champions (i.e., select key individuals who will dedicate themselves to promoting HCV care)
|
40 (50)
|
0.29
|
0.01
|
|
49
|
Organize support teams of clinicians who are caring for patients with HCV and given them time to share the lessons learned and support one another’s learning
|
21 (26)
|
0.16
|
0.18
|
|
50
|
Use advisory boards and interdisciplinary workgroups to provide input into HCV policies and elicit recommendations
|
21 (26)
|
0.09
|
0.46
|
|
51
|
Seek the guidance of experts in implementation
|
35 (44)
|
−0.01
|
0.92
|
|
52
|
Build on existing high-quality working relationships and networks to promote information sharing and problem solving related to implementing HCV care
|
49 (61)
|
0.24
|
0.04
|
|
53
|
Use modeling or simulated change
|
10 (13)
|
0.25
|
0.04
|
|
54
|
Partner with a university to share ideas
|
11 (14)
|
0.27
|
0.02
|
|
55
|
Make efforts to identify early adopters to learn from their experiences
|
13 (16)
|
0.32
|
<0.01
|
|
56
|
Visit other sites outside your medical center to try to learn from their experiences
|
12 (15)
|
0.30
|
0.01
|
|
57
|
Develop an implementation glossary
|
2 (3)
|
0.17
|
0.15
|
|
58
|
Involve executive boards
|
18 (23)
|
0.15
|
0.21
|
| |
In FY15 did your center employ any of these evaluative and iterative strategies to promote HCV care in your center?
|
2 (3)
| | |
|
59
|
Assess for readiness and identify barriers and facilitators to change (e.g., administer the organizational readiness to change survey)
|
21 (26)
|
0.16
|
0.20
|
|
60
|
Conduct a local needs assessment (i.e., collect data to determine how best to change things)
|
36 (45)
|
0.12
|
0.31
|
|
61
|
Develop a formal implementation blueprint (i.e., make a written plan of goals and strategies)
|
27 (34)
|
0.11
|
0.37
|
|
62
|
Start with small pilot studies and then scale them up
|
18 (23)
|
0.08
|
0.50
|
|
63
|
Collect and summarize clinical performance data and give it to clinicians and administrators to implement changes in a cyclical fashion using small tests of change before making system-wide changes
|
17 (21)
|
0.25
|
0.04
|
|
64
|
Conduct small tests of change, measured outcomes, and then refined these tests
|
15 (19)
|
0.11
|
0.36
|
|
65
|
Develop and use tools for quality monitoring (this includes standards, protocols and measures to monitor quality)
|
33 (41)
|
0.07
|
0.56
|
|
66
|
Develop and organize systems that monitor clinical processes and/or outcomes for the purpose of quality assurance and improvement (i.e., create an overall system for monitoring quality--not just tools to use in quality monitoring, which is addressed in the last item)
|
24 (30)
|
0.18
|
0.14
|
|
67
|
Intentionally examine the efforts to promote HCV care
|
49 (61)
|
0.08
|
0.49
|
|
68
|
Develop strategies to obtain and use patient and family feedback
|
16 (20)
|
−0.11
|
0.35
|
| |
In FY15 did your center employ any of these strategies to engage patient consumers to promote HCV care in your center?
| | | |
|
69
|
Involve patients/consumers and family members
|
40 (50)
|
0.01
|
0.91
|
|
70
|
Engage in efforts to prepare patients to be active participants in HCV care (e.g., conduct education sessions to teach patients about what questions to ask about HCV treatment)
|
50 (63)
|
0.39
|
<0.01
|
|
71
|
Intervene with patients/consumers to promote uptake and adherence to HCV treatment
|
57 (71)
|
0.08
|
0.51
|
|
72
|
Use mass media (e.g., local public service announcements; magazines like VANGUARD, newsletters, online/social media outlets) to reach large numbers of people
|
14 (18)
|
0.00
|
0.98
|
|
73
|
Promote demand for HCV care among patients through any other means
|
32 (40)
|
0.19
|
0.12
|
