program distinguishing 11 higher-performing facilities from 11 lower-performing facilities [15]. LWW Facilities with medium volume, low risk patients, few complex clinical programs, and small or no research and teaching programs. Google Scholar. Annu Rev Public Health. endstream endobj 1218 0 obj <>/Metadata 83 0 R/Pages 1215 0 R/StructTreeRoot 107 0 R/Type/Catalog/ViewerPreferences 1232 0 R>> endobj 1219 0 obj <>/MediaBox[0 0 612 792]/Parent 1215 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1220 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Implement Sci. Using this approach, we inductively analyzed the entire dataset and reduced the number of factors to those most likely to inform model development in the next steps of configurational analyses. , : .. FY 2017 Facility Complexity Level Model. WebAs of the last reported data extraction date for Fiscal Year 2015 (September 30, 2015), the Veterans Health Administration (VHA) had a total of 1,241 active medical facilities. Coordinator is a key program leadership position. Trends in Obesity Among Adults in the United States, 2005 to 2014. Facilities are classified into three levels with Level 1 representing the most complex facilities, Level 2 moderately complex facilities, and Level 3 the least complex The overall model had a consistency score of 85% (40/47) and a coverage score of 78% (40/51). 2020;60(8):156674. The .gov means its official.Federal government websites often end in .gov or .mil. Sorry, no results were found for your search criteria. The final model included 78% of the higher reach sites with 85% consistency indicating a meaningful and reliable solution. Sullivan JL, Shwartz M, Stolzmann K, Afable MK, Burgess JF. If you are a Veteran in crisis or concerned about one, connect with our caring, qualified responders for confidential help. WebThe VAs Facility Complexity Model classifies VA medical facilities at levels 1a, 1b, 1c, 2, or 3. Glasgow RE, Vogt TM, Boles SM. For any treatment program to have meaningful population-level impact, programs must successfully reach patients to engage them in treatment [7]. Weight management program. Table1 lists these questions and the final integrated meta-factor used in the analysis. 2017;46(4):95487. Correspondence to BMC Health Services Research Cite this article. Within some VHA medical centers, patients participate in the MOVE! Our findings will inform recommendations about optimal program structures for obesity treatment within VHA. Springer Nature. It complies with the VHA definition of non-research operations activities outlined in section 5a of the 2019 VHA Program Guide 1200.21: VHA Operations Activities That May Constitute Research, meeting both specified conditions: (1) the evaluation was designed and implemented for internal VA purposes and (2) not designed to produce information to expand the knowledge base of a scientific discipline. RE and JAB prepared and constructed the dataset used in the configurational analyses. 2011;1(4):55160. 2017. $$X"A@-#K Hg =$ To reduce dimensionality, we further simplified the original five-level designation to three categories based on overall patient volume: high complexity level (VHA complexity level 1a, high patient volume); medium complexity level (VHA complexity levels 1b, 1c, and 2, medium and medium-high patient volumes); and low complexity level (VHA complexity level 3, low patient volume). Petrik AF, Green B, Schneider J, Miech EJ, Coury J, Retecki S, et al. 2020;58(5):e31-e8. At the high end of the complexity continuum are urban medical centers with high overall patient volume, large numbers of high risk patients, complex clinical programs, and large research and teaching programs. This VHA directive also updates the In this respect, configurational analysis can help address a long-standing challenge in health services research: how to account for local context in cross-case analysis. Applying configurational analysis methods offers a unique opportunity to explore the link between reach and these facility-level treatment arrangements, including bariatric surgery, pharmacotherapy, and a wide range of treatment options within the MOVE! JAMA. These methods operate within a different paradigm than traditional methods like logistic regression or qualitative research, and their findings can complement those generated by other approaches [14]. WebFacilities with medium-high volume, medium risk patients, some complex clinical programs, and medium sized research and teaching programs 2-Medium complexity Facilities with For example, the role of MOVE! This total Chapter 1 Overview and Location of VHA Medical Facilities It is important to note that three of the solution pathways are context-based; the solution pathway depends on thecomplexity of the medical center. Med Care. . https://doi.org/10.1186/s12913-021-06774-w, DOI: https://doi.org/10.1186/s12913-021-06774-w. Programs with the top 40% highest reach scores (n=51) were compared to those in the lowest 40% (n=51). Implement Sci. Reach measures for the higher reach group ranged from 3.3 to 13.1 per 1000 Veterans; measures for the lower reach group ranged from 0 to 2.3 per 1000 Veterans. Facility-based MOVE! This Power BI Dashboard illustrates infection data for your chosen medical facility. statement and Recommendations included the need for integrated multi-component treatment [2], requiring coordination across domains of treatment including bariatric surgery, pharmacotherapy, and lifestyle intervention [27] to engage patients in treatments tailored to meet their needs. BMC Health Serv Res 21, 797 (2021). WebPK !d {k "ZJqXD N{c DdH x x: W;,EM ND]C T>x g2(f Fc#pS!& sC I"4(~aU Bc"&/|q W.`m 0 k nM [ coordinator or a MOVE! Handbook on Implementation Science. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Hospital Compare Data helps consumers make decisions about where to get health care and encourages hospitals to improve the quality of care. Breland JY, Phibbs CS, Hoggatt KJ, Washington DL, Lee J, Haskell S, et al. Information about weight management programming at each facility relied on self-reporting by VHA staff who may or may not have had close involvement with MOVE!, pharmacotherapy treatments, or bariatric surgery. Google Scholar. VHA Office of Capital Asset Management Engineering and Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. If no configurations met this dual threshold, we iteratively lowered the specified consistency level by 5 points (e.g., from 100 to 95%, etc.) A Systems Science Perspective on Addressing Obesity in the Veterans Health Administration. MBF, WW,AA, SDR, SAS and LJD were major contributors to interpretation and in writing the manuscript. WebThe five levels of hospital complexity are: 1a, 1b, 1c, 2, and 3, in descending order of complexity with level 1a the most complex and level 3 the least complex. Veterans Affairs Center for Health Information & Communication, VA EXTEND QUERI, Roudebush VA Medical Center, Indianapolis, USA, Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan, Ann Arbor, USA, Michelle B. Freitag,Richard R. Evans,Jennifer A. Burns,Wyndy L. Wiitala,Ann Annis&Laura J. Damschroder, National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, North Carolina, USA, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA, You can also search for this author in VA facility data is shown on some quality measures found on the Centers for Medicare and Medicaid Services (CMS) Care Compare website. Gerontologist. 2012 VHA Facility Quality and Safety Report - Veterans Affairs volume21, Articlenumber:797 (2021) Obesity is a well-established risk factor associated with increased morbidity in diabetes and hypertension in particular as well as increased mortality overall [3, 4]. . , () , : , : , : , , , , (), () , : () , () , , , , , , , , , , , , , , , , , , , ! Am J Prev Med. ( .) About VHA - Veterans Health Administration - Veterans Affairs Circulation. weight management program prior to bariatric surgery and may participate in maintenance programming post-surgery. Article 2009;36(1):2434. List of Veterans Affairs medical facilities - Wikipedia The site is secure.The https:// ensures that you're connecting to the official website and that any information you provide is encrypted and sent securely. 2011;41(5):45764. 2013;8:117. J Gen Intern Med. Last updated November 03, 2021. Sociol Methods Res. 2017;32(Suppl 1):910. How modeling works for operations and maintenance. SAIL FY2021 Hospital Performance - All Facilities The final model comprised five solution pathways that each led to higher reach, indicating that multiple combinations can lead to the same outcome; this demonstrates equifinality in solutions. , (): () () . program. Miech, E.J., Freitag, M.B., Evans, R.R. Learn more about what invasive procedure complexity means. This survey data was linked to reach scores available through administrative data. A Longitudinal Assessment of the Effect of Resident-Centered Care on Quality in Veterans Health Administration Community Living Centers. We would like to thank and acknowledge our colleagues Jane Kim, Michael Goldstein, Sophia Califano, Eugene Oddone, and Felicia McCant for their on-going support for this work, including early conceptualization. Cragun D. Configurational comparative methods. The most complex VA facilities are designated as Complexity 1a. Health Serv Res. (): , () , . Configurational methods have been applied in political science and sociology since the 1980s and are increasingly being used in health services research. All conditions with circles within that column are part of the pathway and jointly lead to higher reach. We considered all one-, two-, and three-condition configurations of conditions instantiated within our dataset that met the designated thresholds for consistency and coverage. Facility-level conditions leading to higher reach: a configurational U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Innovations in Mixed Methods Evaluations. R package. Level-1a facilities are the most complex and level 3 facilities are the least complex. In this evaluation, configurational analyses revealed specific combinations of facility-level obesity treatment programming that consistently and uniquely distinguished higher-reach from lower-reach facilities. During the data reduction process, four different categories of factors and ten different conditions were represented by the range of configurations that met our dual threshold criteria (see Table2). The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, providing care at 1,321 health care facilities, including 172 VA Chambers DA, Glasgow RE, Stange KC. Coverage is a metric that indicates how broadly a solution accounts for an outcome and is calculated as the number of cases with the configuration and the outcome present divided by the total number of cases with the outcome. 1245 0 obj <>stream Am J Public Health. These results also illustrate equifinality: there is more than one way to achieve higher reach to patients who may benefit from obesity treatment. This program evaluation qualified as non-research quality improvement activity conducted under the authority of VHA operations. Our results add credence to this recommendation: all but one solution pathway involved at least two of three domains of care and one pathway included conditions across all three. We assessed models based on their overall consistency and coverage, as well as potential model ambiguity (when competing models explain the outcome equally well as reflected by similar consistency and coverage scores) [26]. visit in 2017 divided by the total number of Veterans at that facility who would benefit from MOVE! VA determines WebComplexity Level 1a. Official websites use .gov. Yakovchenko V, Miech EJ, Chinman MJ, Chartier M, Gonzalez R, Kirchner JE, et al. Wiltsey Stirman S, Baumann AA, Miller CJ. For each facility, the score represented the total number of patients with at least one MOVE! in 2017, then multiplying that number by 1000. comprehensive lifestyle intervention, three conditions relate to pharmacotherapy, and one condition relates to bariatric surgery. Glasgow RE, Estabrooks PE. , . The final solution consisted of 5 distinct pathways comprising combinations of program components related to pharmacotherapy, bariatric surgery, and comprehensive lifestyle intervention; 3 of the 5 pathways depended on the size/complexity of medical center. The merged dataset comprised over 30 factors, many ofwhich were multi-value, with multiple responses possible. Soc Sci Med. Best practices in the Veterans Health Administrations MOVE! Implement Sci. Each of the sections are color-coded. While the Veterans Health Administration (VHA) MOVE! hWo6l 0%7 MR4i-D\i$8]0tD=w#. Figure1 also lists overall model consistency and coverage scores that is an aggregated score across all five solution paths. At the bottom of Fig.1, individual sites are listed by study identification number. more than 20h per week AND programs where bariatric surgery is considered as part of treatment planning for MOVE! Facilities - Veterans Affairs Configurational comparative methods: Qualitative comparative analysis (QCA) and related techniques. A key tenet within implementation science is that programs must be adapted to local conditions to optimize and sustain outcomes [29,30,31]. programs vary in structures, processes of programming, and levels of reach, with no single factor explaining variation in reach. A study by Kahwati et al., for example, used configurational methods to identify facility structure, policies, and processes related to the VA MOVE! () () , () : , . VA facility data is shown on some quality measures found on the Centers for Medicare and Medicaid Services (CMS) Care Compare website. Consistency is a metric that indicates how reliably a solution yields an outcome and is calculated as the number of cases with the solution configuration and the targeted outcome divided by the total number of cases with the solution configuration. Ml`W __A@b a,\?`apil`n`hpiH`iP`@!A! Search. Cheltenham: Edward Elgar Publishing; 2020. hbbd``b`k@D` If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 0 We then assessed all configurations that satisfied those thresholds. VHA Directive Facility Procedure Complexity Three separate questions wereasked related to the MOVE! We continued relaxing the consistency threshold until there were at least two potential configurations of facility-level conditions that met the specified consistency level and the 15% coverage threshold. Thus, it is insufficient to offer only lifestyle intervention without the availability of pharmacotherapies, or pharmacotherapies without bariatric surgery options. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Atkins D. Improving Weight Management among Veterans. Recent estimates of the prevalence of obesity among Veterans receiving care in VHA are over 40% [1]. Harris K, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based selfmanagement interventions for asthma in children and adolescents: a mixed methods systematic review. Figure1 lists consistency for each of the pathways and ranges from 80% (SP2-SP3) to 92% (SP4), indicating high reliability for all pathways. Our solution for higher reach included three context-dependent pathways, which we could identify because configurational analysis has the capacity to model Boolean disjunctions, where different paths lead to the same outcome. CLI program. These findings represent Boolean conjunctions, where multiple conditions together yield an outcome. Raffa SD, Maciejewski ML, Zimmerman LE, Damschroder LJ, Estabrooks PA, Ackermann RT, et al. Your US state privacy rights, PubMed Briefly, we began by using the minimally sufficient conditions (i.e., msc) function within the R package cna [25] to look across all candidate factors for all 102 facilities to identify configurations of conditions with strong connections to the outcome condition (i.e., high reach). Edward J. Miech. Before sharing sensitive information, make sure you're on a federal government site. A similar process was used to create meta-factors indicatingthe degree of presence of a Physician Champion (another key role) and accessibility of weight loss medications. Chambers DA, Norton WE. Location Facility Listing Select a "List By" option to customize your report. The inclusion of the latter condition is a bit harder to understand; the presence of restrictions in a high complexity site may indicate active involvement of pharmacists in treatment or may be a proxy for another unmeasured factor. 2019;1(1):CD011651. As organizational context can play as large a role in determining outcomes as program components themselves [32, 33], the ability of our configurational analysis to detect one pathway for large urban medical centers and another pathway for smaller rural facilities underscores the potential contribution of this approach to the larger repertoire of evaluation strategies within health services research. VA/DOD clinical practice guideline for screening and management of overweight and obesity: Version 3.0 2020.
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