, Volume 59, Issue 2, pp 273-281
Date: 10 Aug 2013

Association Between Facility Characteristics and the Process of Care Delivered to Patients with Hepatitis C Virus Infection

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Abstract

Background

Available data suggest problems in the process of care provided to patients with chronic hepatitis C (HCV). However, the solutions to these problems are less obvious. Healthcare facility factors are potentially modifiable and may enhance process quality in HCV treatment.

Methods

We evaluated the relationship between the process of HCV care and facility factors including number of weekly half-day HCV clinics per 1,000 HCV patients, HCV-specific quality-improvement initiatives, and administrative service of the HCV clinic (gastroenterology, infectious disease, primary care) for a cohort of 34,258 patients who sought care in 126 Veterans Affairs facilities during 2003–2006. We measured HCV care on the basis of 23 HCV-specific process measures capturing pretreatment (seven measures), preventive and/or comorbid (seven measures), and treatment and treatment monitoring care (nine measures).

Results

Patients seen at a facility with >8 half-day clinics were 52 % more likely to receive overall indicated care (OR 1.52, 95 % CI 1.13–2.05). Patients seen at a facility with >3 HCV quality improvement initiatives were more likely to receive better preventive and/or comorbid care (OR 1.32, 95 % CI 1.00–1.74). Compared with patients in facilities with no dedicated HCV clinic, patients at facilities with gastroenterology-based clinics received better pretreatment care (OR 1.36, 95 % CI 1.01–1.85) and more antiviral treatment (OR 1.45, 95 % CI 1.06–1.97) whereas those at facilities with infectious disease-based or primary care-based clinics received better preventive and/or comorbid care (OR 1.59, 95 % CI 1.06–2.39 and 1.84, 95 % CI 1.21–2.79 respectively).

Conclusion

Several facility factors affected the process of HCV care. These factors may serve as targets for quality-improvement efforts.

Disclaimer: The opinions and assertions contained herein are solely the views of the authors and are not to be construed as official or as reflecting the views of the Department of Veteran Affairs.