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Completed Projects
The Implementation and Diffusion of Advanced Clinic Access in VA Medical Centers
VA has embarked on a system-wide effort to improve veterans’ access to health care through the adoption of Advanced Clinic Access (ACA), using the ACA principles developed by the Institute for Healthcare Improvement (IHI). The initiative builds on an earlier VA project with IHI in 1999 to introduce ACA to a clinical team in each of 134 VA medical centers. In the current initiative, VA is moving beyond the initial team to spread Advanced Access to all clinics in six target clinic areas: primary care, audiology, orthopedics, eye care, cardiology, and urology. The key issue now is the institutionalization of the ACA initiative within VA. The MDRC is evaluating the ACA spread effort at the request of the Chairs of ACA National Steering Committee.
Study Design
We are using the naturally occurring variation in this national initiative to better understand the factors that contribute to the successful implementation and diffusion of innovation. Our evaluation focuses on 77 facilities selected to represent high, medium, and low performance in waiting times for clinic appointments. A secondary focus will be on six sites selected as case studies for more in-depth understanding of the factors that affect ACA adoption and veteran access.
The evaluation addresses three fundamental questions:
Intervention: To what extent is implementation of the IHI model of 10 key changes for Advanced Access associated with short wait times in the six target clinic areas and/or improvement in patient satisfaction with appointment access?
Context: Do certain psychosocial features of the department and/or facility enhance or impede the implementation and effectiveness of the 10 key access changes?
Diffusion: Do the various strategies used to promote ACA affect the diffusion of the 10 key changes model to clinics across that facility?
The study uses three major sources of data:
Secondary analyses of VA databases to measure wait times, patient satisfaction, and context variables;
Surveys of front-line staff to measure the degree and diffusion of ACA implementation at the clinic level in each of the six target clinic areas, and to assess the operation of teams in the clinic areas; and
Structured telephone interviews with facility points of contact to document implementation and spread of ACA at the facility level.
The evaluation is scheduled for completion in April 2003.
Using the Findings
The evaluation findings can be used to both elevate performance at those sites where ACA has been less successful to date, and to advance VA as a learning organization by building knowledge that can be used to accelerate the uptake of future innovations into the organizational system.
The study is funded with VA Medical Care dollars.
For more information, contact Carol VanDeusen Lukas, EdD, (carol.vandeusenlukas@va.gov ) or Mark Meterko, PhD (mark.meterko@va.gov ).
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