The Association of Hospital Characteristics and Quality Improvement Activities in Veterans Administration Inpatient Medical Services
Operations and Technology Management
Authors: Joseph D. Restuccia, David Mohr, Mark Meterko, Kelly Stolzmann, and Peter Kaboli
Despite considerable recent attention to hospital quality improvement, relatively little is known about the extent hospitals are engaging in quality improvement activities (QIAs) and the hospital characteristics associated with QIAs. We developed and in 2011 administered a survey to Chiefs of Medicine (COMs) at the 124 Veterans Administration with inpatient medical services asking about the extent of use of 27 QIAs on a 5 point Likert scale, anchored by 0 = strongly disagree and 4 = strongly agree. We used multi-trait analysis to group QIAs into 3 scales which we characterized as prevention (e.g. prevention of adverse drug events), information gathering (e.g. benchmarking with other hospitals), and infrastructure (e.g. evidence-based guidelines). We also developed a scale about alignment of goals between senior leaders and the inpatient medicine service. We regressed each QI activity scale and total QIAs on use of hospitalists (physicians who practice only inpatient medicine), use of nurse practitioners or physician assistants, and alignment. Covariates included operating beds, occupancy rate, years of operation, region of country, urban/non-urban, and teaching status. After exclusion of surveys with missing data, we obtained an 84 percent response rate. The most frequently used QIAs were those related to prevention with a mean of 3.38 (with Information gathering = 2.27 and infrastructure = 2.25). Two factors were consistent statistically significant predictors of QIAs, the presence of hospitalists and alignment of senior management and the inpatient medical service. Goal alignment and use of physicians specializing in provision of inpatient medicine appear to enable implementation of QIAs.