Organizational predictors of adherence to ambulatory care screening guidelines

Thomas E. Vaughn, Kimberly D. McCoy, Bonnie J. BootsMiller, Robert F. Woolson, Bernard Sorofman, Toni Tripp-Reimer, Jonathan Perlin, Bradley Doebbeling

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to identify hospital organizational characteristics consistently associated with adherence to multiple clinical practice guidelines (CPGs). We examined the relationship between organizational and patient population characteristics and adherence to three screening CPGs implemented throughout the Veterans Health Administration (VHA). MATERIALS AND METHODS. The study included 114 acute care facilities. Three sources of data were used: 1998 American Hospital Association data, VHA External Peer Review Program data for 1998 and 1999, and the 1999 Veterans Satisfaction Survey. Organizational characteristics likely to affect adherence with the CPGs were classified into five conceptual domains (clinical emphasis, operational capacity, patient population, professionalism, and urbanicity). Organizational characteristics were ranked, based on their standardized beta coefficients in bivariate logistic regressions predicting the likelihood of adherence. Within-domain multivariable logistic analyses assessed the robustness of individual predictors of CPG adherence, controlling for other organizational factors within the same domain. RESULTS. Overall, 46 of 48 relationships in the bivariate logistic analyses were significant, and 43 of these remained significant in the within-domain multivariate analyses. The relative rankings of the variables as predictors of CPG adherence within conceptual domains were also quite consistent. CONCLUSIONS. Strong evidence was found for the importance of specific organizational factors, including mission, capacity, professionalism, and patient population characteristics that influence CPG adherence in a large multiinstitutional sample involving multiple provider practices. Research and programs to improve adherence to CPGs and other quality improvement activities in hospitals should incorporate these organizational factors.

Original languageEnglish (US)
Pages (from-to)1172-1185
Number of pages14
JournalMedical Care
Volume40
Issue number12
DOIs
StatePublished - Dec 2002
Externally publishedYes

Fingerprint

Ambulatory Care
Practice Guidelines
Guidelines
Guideline Adherence
Veterans Health
United States Department of Veterans Affairs
Population Characteristics
logistics
American Hospital Association
Peer Review
Information Storage and Retrieval
Veterans
Quality Improvement
peer review
health
Multivariate Analysis
Logistic Models
ranking
regression
Research

Keywords

  • Guidelines
  • Innovation
  • Organization and administration
  • Quality

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Vaughn, T. E., McCoy, K. D., BootsMiller, B. J., Woolson, R. F., Sorofman, B., Tripp-Reimer, T., ... Doebbeling, B. (2002). Organizational predictors of adherence to ambulatory care screening guidelines. Medical Care, 40(12), 1172-1185. https://doi.org/10.1097/00005650-200212000-00005

Organizational predictors of adherence to ambulatory care screening guidelines. / Vaughn, Thomas E.; McCoy, Kimberly D.; BootsMiller, Bonnie J.; Woolson, Robert F.; Sorofman, Bernard; Tripp-Reimer, Toni; Perlin, Jonathan; Doebbeling, Bradley.

In: Medical Care, Vol. 40, No. 12, 12.2002, p. 1172-1185.

Research output: Contribution to journalArticle

Vaughn, TE, McCoy, KD, BootsMiller, BJ, Woolson, RF, Sorofman, B, Tripp-Reimer, T, Perlin, J & Doebbeling, B 2002, 'Organizational predictors of adherence to ambulatory care screening guidelines', Medical Care, vol. 40, no. 12, pp. 1172-1185. https://doi.org/10.1097/00005650-200212000-00005
Vaughn TE, McCoy KD, BootsMiller BJ, Woolson RF, Sorofman B, Tripp-Reimer T et al. Organizational predictors of adherence to ambulatory care screening guidelines. Medical Care. 2002 Dec;40(12):1172-1185. https://doi.org/10.1097/00005650-200212000-00005
Vaughn, Thomas E. ; McCoy, Kimberly D. ; BootsMiller, Bonnie J. ; Woolson, Robert F. ; Sorofman, Bernard ; Tripp-Reimer, Toni ; Perlin, Jonathan ; Doebbeling, Bradley. / Organizational predictors of adherence to ambulatory care screening guidelines. In: Medical Care. 2002 ; Vol. 40, No. 12. pp. 1172-1185.
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