Association Between Facility Characteristics and the Process of Care Delivered to Patients with Hepatitis C Virus Infection
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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.
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).
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).
Several facility factors affected the process of HCV care. These factors may serve as targets for quality-improvement efforts.
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- Association Between Facility Characteristics and the Process of Care Delivered to Patients with Hepatitis C Virus Infection
Digestive Diseases and Sciences
Volume 59, Issue 2 , pp 273-281
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Process of care
- Structure of care
- Health services
- Chronic hepatitis C
- Quality improvement
- Industry Sectors
- Author Affiliations
- 1. Houston VA HSR&D Center of Excellence, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA
- 2. Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- 3. Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- 4. John Cochran VA Medical Center, St. Louis, MO, USA
- 5. Office of Public Health/Clinical Public Health, Washington, DC, USA
- 6. VA Puget Health Care System, Seattle, WA, USA
- 11. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- 7. VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA, USA
- 10. Department of Medicine, Stanford University College of Medicine, Palo Alto, CA, USA
- 9. VA HSR&D Center of Excellence, Health Services Research and Development Service, VA Palo Alto, Palo Alto, CA, USA