Powered by: Blackwell Publishing

HRET - Health Research & Educational Trust

HSR - Health Services Research

Impacting Health Practice and Policy Through State-of-the-Art Research and Thinking

Our Next Issue

February 2018
Coming Soon! Read

< ABSTRACT LIST

VOLUME 47 | NUMBER 4 | AUGUST 2012


Organizational Characteristics of High- and Low-Performing Anticoagulation Clinics in the Veterans Health Administration

Keywords: Qualitative research;quality of health care;anticoagulants;pharmacists;organization and administration

Objective. 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 Source/Study Setting. Three high outlier and three low outlier ACCs in the Veterans Health Administration (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 ACCs in the VA system shared six relatively recognizable characteristics. Efforts to improve performance should focus on these domains.

back to top | back to article index | purchase full article

Copyright© 2017, Health Research & Educational Trust. All rights reserved. Content Disclaimer
Health Research & Educational Trust, 155 North Wacker, 4th Floor Chicago, IL 60606 (312) 422.2600