Table 1 Strategies by cluster and correlation with treatment starts

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