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Organizational Characteristics of High‐ and Low‐Performing Anticoagulation Clinics in the Veterans Health Administration
Author(s) -
Rose Adam J.,
Petrakis Beth Ann,
Callahan Patricia,
Mambourg Scott,
Patel Dimple,
Hylek Elaine M.,
Bokhour Barbara G.
Publication year - 2012
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2011.01377.x
Subject(s) - staffing , medicine , outlier , pharmacist , quality management , thematic analysis , documentation , data collection , workflow , focus group , process management , nursing , operations management , qualitative research , computer science , business , pharmacy , management system , database , social science , statistics , mathematics , marketing , artificial intelligence , sociology , economics , programming language
Objective Anticoagulation clinics ( ACC s) can improve anticoagulation control and prevent adverse events. However, ACC s 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 ACC s. Data Sources/Study Setting Three high outlier and three low outlier ACC s in the V eterans H ealth A dministration ( VA ). Study Design 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. Principal Findings 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. Conclusions The top‐performing ACC s in the VA system shared six relatively recognizable characteristics. Efforts to improve performance should focus on these domains.