Informatics Implementation in the Veterans Health Administration ...

Informatics Implementation in the Veterans Health Administration (VHA) Healthcare System to Improve Quality of Care Bradley N. Doebbeling, MD, MSc, 1-3 Thomas E. Vaughn, PhD, 4 Kimberly D. McCoy, MS,1 Peter Glassman, MBBS, MSc5 1 VA HSR&D Center on Implementing Evidence-based Practice, Roudebush VAMC; 2 Indiana University (IU) Center for Health Services & Outcomes Research, Regenstrief Institute, Inc.; 3Department of Medicine, IU School of Medicine, Indianapolis, IN; 4 Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA; 5Department of Medicine, VA Greater Los Angeles Healthcare System, Geffen School of Medicine at UCLA, Los Angeles, CA. ABSTRACT We describe VHA’s information technology (IT) implementation from the providers’ perspective, and identify factors influencing its effective implementation to improve care. We surveyed a stratified random national sample of 4227 clinicians from three VHA primary care provider groups: 1) physicians; 2) nurse practitioners, physician assistants; and 3) nurses. Facility-level IT support availability was rated across six dimensions: 1) access to literature/evidence, 2) computerized decision support, 3) computerized clinical data, 4) error reduction, 5) provider communication, and 6) patient communication. Factor analysis identified a 5item scale (IT clinical support, α = 0.76). Generalized estimating equation models identified factors influencing IT clinical support. Complete data from 123 hospitals (1777 providers) were included. The final model showed IT clinical support was higher in hospitals that were urban (p