Furnari S, Crilly D, Misangyi VF, Greckhamer T, Fiss PC, Aguilera R. Capturing causal complexity: heuristics for configurational theorizing. Identifying the Implementation Conditions Associated With Positive Outcomes in a Successful Nursing Facility Demonstration Project. hbbd``b`k@D` 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. Your US state privacy rights, Coordinator is a key program leadership position. 2023 BioMed Central Ltd unless otherwise stated. 1217 0 obj <> endobj 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. Google Scholar. Though coverage was high (78%), 11 of the 51 higher reach facilities were not included in any of the five solution pathways, indicating a possible role for additional factors beyond those in the model. 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 1230 0 obj <>/Filter/FlateDecode/ID[<02B9C1E5EF11814E8A6D9DAC3A280922>]/Index[1217 29]/Info 1216 0 R/Length 74/Prev 291583/Root 1218 0 R/Size 1246/Type/XRef/W[1 2 1]>>stream 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. The Complex Interplay Between Specific Operational Changes and Local Context When Improving Cardiovascular Outcomes. We developed models by iteratively using model-building functions within the Coincidence Analysis (i.e., cna) software package in R [25]. We generated condition tables by specifying a consistency threshold of 100% and a coverage score of at least 15% to avoid overfitting. version 2.1.1 ed2018. program representatives responded to the survey and had complete reach data. 2018;15:E02. 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). The third meta-factor consisted of a 4-point ordinal scale representing accessibility of weight-loss medications for MOVE! Terms and Conditions, In 2017, NCP collaborated with VHAs Healthcare Analysis and Information Group (HAIG) to field a comprehensive survey of weight management programming across VHA. The most complex VA facilities are designated as Complexity 1a. , (): () () . The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans. Implement Sci. Three conditions relate to context of the medical center (high, medium, or low complexity). LWW Facilities types (level of care types) are listed in the VISN tables below as: Network System Headquarters (HQ) Network Health Care System (HCS) VA medical centers PubMedGoogle Scholar. Chapter 1 Overview and Location of VHA Medical Facilities 2017. BMC Health Services Research programs vary in structures, processes of programming, and levels of reach, with no single factor explaining variation in reach. Sociol Methods Res. The National Center for Health Promotion and Disease Prevention (NCP) leads weight management policy and provides support to MOVE! Circulation. List of Veterans Affairs medical facilities - Wikipedia Solutions demonstrated the importance of howlocal context plus specific program components linked together to account for a key implementation outcome. Edward J. Miech. program distinguishing 11 higher-performing facilities from 11 lower-performing facilities [15]. In this analysis, reach scores were calculated using treatment data from the VHA Corporate Data Warehouse. Department of Veterans Affairs. Secure .gov websites use HTTPS. A .gov website belongs to an official government organization in the United States. Cheltenham: Edward Elgar Publishing; 2020. The addition of BAM indicates an exceptionally expansive MOVE! hWo6l 0%7 MR4i-D\i$8]0tD=w#. Configurational analysis is one method within a broader family of configurational comparative methods, which include Qualitative Comparative Analysis and more recently Coincidence Analysis. Each of the sections are color-coded. Location Facility Listing Select a "List By" option to customize your report. Miech, E.J., Freitag, M.B., Evans, R.R. () : . 2011;1(4):55160. The 5 pathways explained 78% (40/51) of the facilities in the higher-reach group with 85% consistency (40/47). , . Like many large health systems seeking to address the obesity epidemic, the Veterans Health Administration (VHA) healthcare system offers several evidence-based weight management options for patients, including a system-wide comprehensive lifestyle intervention (CLI) program, pharmacotherapies, and bariatric surgery [2]. The merged dataset comprised over 30 factors, many ofwhich were multi-value, with multiple responses possible. 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. 2016;51(4 Suppl 2):S124-31. Veterans Health Administration (VHA). 2019;1(1):CD011651. EJM and LJD analyzed and interpreted data and were major contributors in writing the manuscript. Raffa SD, Maciejewski ML, Zimmerman LE, Damschroder LJ, Estabrooks PA, Ackermann RT, et al. Am J Public Health. One hundred twenty-seven MOVE! Implement Sci. SAIL FY2021 Hospital Performance - All Facilities For example, a 2017 study on the implementation of the Diabetes Prevention Program in VHA a complex lifestyle intervention found that the biggest challenges to implementation were barriers related to reach [8]. This program evaluation qualified as non-research quality improvement activity conducted under the authority of VHA operations. 2017;32(Suppl 1):7982. Within low complexity medical centers (smaller, often rural centers), having maintenance programming with no restrictions on weight loss medication refills led to higher reach; this pathway explained all 11 low complexity sites with higher reach in our dataset. Ann Fam Med. Raw coverage indicates the percentage of high reach sites that are included in each solution pathway; raw coverage ranged from 8% (SP3) to 31% (SP2). To create the analytic dataset for the configurational analysis we merged two different datasets. 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 [ A Systems Science Perspective on Addressing Obesity in the Veterans Health Administration. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. VA facility data is shown on some quality measures found on the Centers for Medicare and Medicaid Services (CMS) Care Compare website. List by: return to top Webcomplexity. Facilities by State - Locations - Veterans Affairs Annu Rev Public Health. program. VA Facility Search | Veterans Affairs 2017;46(4):95487. A study by Kahwati et al., for example, used configurational methods to identify facility structure, policies, and processes related to the VA MOVE! Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. The .gov means its official.Federal government websites often end in .gov or .mil. Department of Veterans Affairs Office of Inspector Columns on the right indicate which conditions are included in each of the five pathways leading to higher reach scores. Level-1a facilities are the most complex and level 3 facilities are the least complex. Figure1 provides a visual depiction of configurational results. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Configurational methods have been applied in political science and sociology since the 1980s and are increasingly being used in health services research. The aim of this study was to identify characteristics of medical center-based obesity treatment program arrangements that lead to higher reach to patients who would benefit from obesity treatment. statement and Strategy Configurations Directly Linked to Higher Hepatitis C Virus Treatment Starts: An Applied Use of Configurational Comparative Methods. The operational survey was administered to 140 medical centers and achieved a 100% response rate. For example, the survey item inquiring about the presence of a MOVE! 2013;309(1):7182. 2017;32(Suppl 1):117. https://doi.org/10.1186/s12913-021-06774-w, DOI: https://doi.org/10.1186/s12913-021-06774-w. Hospital Compare Data | Veterans Affairs Kahwati LC, Lance TX, Jones KR, Kinsinger LS. )H86el }1Hs (:kcId$ Coordinator was scaled based on the level of time dedicated to the program, with 6 possible responses ranging from 0 to 100%. WebHere's how you know. VA facility data is shown on some quality measures found on the Centers for Medicare and Medicaid Services (CMS) Care Compare website. This configurational analysis was conducted using a dataset comprised of program survey responses from all VHA medical centers, combined with administration data to compute reach scores. The final model included 78% of the higher reach sites with 85% consistency indicating a meaningful and reliable solution. Oakland: Univ of California Press; 2014. VHA Directive Facility Procedure Complexity Designation Facilities with reach within the middle quintile (n=25) were dropped from the analysis to build in a meaningful gap between the higher reach (i.e., upper 40%) and lower reach (i.e., bottom 40%) facilities; 102 facilities were in the analytic sample. Cohen DJ, Sweeney SM, Miller WL, Hall JD, Miech EJ, Springer RJ, et al. Krein SL, Damschroder LJ, Kowalski CP, Forman J, Hofer TP, Saint S. The influence of organizational context on quality improvement and patient safety efforts in infection prevention: a multi-center qualitative study. Sullivan JL, Shwartz M, Stolzmann K, Afable MK, Burgess JF. visit in 2017 divided by the total number of Veterans at that facility who would benefit from MOVE! volume21, Articlenumber:797 (2021) An official website of the United States government. Search. Glasgow RE, Vogt TM, Boles SM. A de-identified version of the configurational data used in the analysis is available from the corresponding author on reasonable request. Article Facilities with medium volume, low risk patients, few complex clinical programs, and small or no research and teaching programs. patients consistently lead to higher reach. A Facilities Same-Day Service Options At Individual Facilities. An official website of the United States government. WebLook up health care performance and satisfaction information at a VA facility. How staffing is currently performed. Glasgow RE, Estabrooks PE. While the Veterans Health Administration (VHA) MOVE! () () , () : , . 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. Next, we proceeded with data reduction by adopting a configurational approach to factor selection that has been described previously [18, 20, 21]. Hospital Compare Data helps consumers make decisions about where to get health care and encourages hospitals to improve the quality of care. A key tenet within implementation science is that programs must be adapted to local conditions to optimize and sustain outcomes [29,30,31]. weight management program prior to bariatric surgery and may participate in maintenance programming post-surgery. CLI program. Department of Veterans Affairs VHA DIRECTIVE 2014;129(25 Suppl 2):S102-38. Table1 lists these questions and the final integrated meta-factor used in the analysis. Facility-level conditions leading to higher reach: a configurational analysis of national VA weight management programming. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. program; only 23% of all facilities reported offering BAM. Reach scores were calculated by dividing the total number of Veterans who are candidates for obesity treatment by the number of new MOVE! MBF, WW,AA, SDR, SAS and LJD were major contributors to interpretation and in writing the manuscript. Cite this article. This Power BI Dashboard illustrates infection data for your chosen medical facility. , () , : , : , : , , , , (), () , : () , () , , , , , , , , , , , , , , , , , , , ! VHA Invasive Procedure Complexity for Surgical Programs If you are a Veteran in crisis or concerned about one, connect with our caring, qualified responders for confidential help. 2016;315(21):228491. Many of them are Veterans themselves. 2018;53(3):181933. Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA). The authors declare that they have no competing interests. Damschroder LJ, Reardon CM, AuYoung M, Moin T, Datta SK, Sparks JB, et al. Web2-Medium complexity. For any treatment program to have meaningful population-level impact, programs must successfully reach patients to engage them in treatment [7]. Configurational comparative methods: Qualitative comparative analysis (QCA) and related techniques. ! Facility-based MOVE! No single condition explained the 51 facilities with the higher-reach outcome; rather, combinations of specific conditions consistently and uniquely distinguished higher reach facilities from lower reach facilities. Petrik AF, Green B, Schneider J, Miech EJ, Coury J, Retecki 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. Reach is a critical component of program evaluation. . These are facilities with the largest levels of volume and patient risk with significant teaching and We considered all one-, two-, and three-condition configurations of conditions instantiated within our dataset that met the designated thresholds for consistency and coverage. endstream endobj startxref WebThe VAs Facility Complexity Model classifies VA medical facilities at levels 1a, 1b, 1c, 2, or 3. et al. The five pathways listed in Fig.1 are indicated by column. About VHA - Veterans Health Administration - Veterans Affairs 2017;12(1):94. First, in the top section of the figure, conditions (i.e., when factors take on specific values) are listed in rows. The HAIG survey achieved a 100% response rate, with all 140 medical centers responding. endstream endobj 1221 0 obj <>stream Palinkas LA, Mendon SJ, Hamilton AB. Of these, the MOVE! Webregarding the infrastructure requirements for VA medical facilities performing invasive procedures in any clinical setting and the complexity of the procedures being performed, as well as the method for monitoring compliance. Of the 140 facilities that responded to the HAIG survey, 127 (91%) had sufficiently complete reach data necessary to calculate the reach outcome. Behavioral weight loss programs, pharmacotherapies, and bariatric surgery are effective treatments for obesity [5]. Veterans Affairs VHA Healthcare Analysis and Information Group, VHA National Center for Health Promotion and Disease Prevention. *Some reports may take a few seconds due to size. Am J Prev Med. comprehensive lifestyle intervention, three conditions relate to pharmacotherapy, and one condition relates to bariatric surgery. Facility-level conditions leading to higher reach: a configurational analysis of national VA weight management programming, https://doi.org/10.1186/s12913-021-06774-w, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, bmchealthservicesresearch@biomedcentral.com. SP3-SP5 each have a condition related to facility complexity.While the absence of refill restrictions is part of the solution for low complexity facilities (SP5), the presence of refill restrictions is onthe solution pathway for high complexity facilities (SP3). 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. Figure1 lists consistency for each of the pathways and ranges from 80% (SP2-SP3) to 92% (SP4), indicating high reliability for all pathways. Last updated November 03, 2021. 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. $$X"A@-#K Hg =$ A System-Level Approach to Overweight and Obesity in the Veterans Health Administration. Sorry, no results were found for your search criteria. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. 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. The final solution consisted of 5 distinct pathways comprising combinations of program components related to pharmacotherapy, bariatric surgery, and comprehensive In health services research, configurational analysis appears to be well-suited to identify how the interplay of specific conditions leads to a complex phenomenon like higher reach within a large system of care. Two of the three meta-factors used 6-point ordinal scales (0=None to 5=Very high/highly active) to represent the degree of presence of a local MOVE! 2017;32(Suppl 1):13. Obesity poses a major challenge to healthcare systems, including the Veterans Health Administration (VHA) [1, 2]. 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]. Before sharing sensitive information, make sure you're on a federal government site. Baumgartner M, Thiem A. A total of 18 sites have the combination of conditions for SP1; 15 sites are higher reach and three sites (not listed in figure) are lower reach. Wiltsey Stirman S, Baumann AA, Miller CJ. The Hickman SE, Miech EJ, Stump TE, Fowler NR, Unroe KT. Thus, consistency is 83% of all cases with the solution path (15/18) and raw coverage is 29% of all cases with higher reach (15/51). VA determines (For examples of items from the HAIG Survey, see Additional File 1). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Yakovchenko V, Miech EJ, Chinman MJ, Chartier M, Gonzalez R, Kirchner JE, et al. VHA Directive Facility Procedure Complexity Not applicable. 2009;36(1):2434. 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. In a condition table, rows contain all configurations of conditions that meet a specified consistency level while column variables include outcome, conditions, consistency and coverage. 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. 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. Our findings will inform recommendations about optimal program structures for obesity treatment within VHA. Same-Day Service Options At Individual Facilities. It provides standardized and detailed information about local obesity treatment programming at each of the 140 facilities. 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. R package. 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]. Cookies policy. Correspondence to Three of these five pathways were context-dependent: distinct pathways leading to higher reach, depended on whether the facility was high-, medium- or low-complexity. Multiple pathways included conditions that spanned across the MOVE! Privacy Configurational analysis draws upon Boolean algebra and set theory to offer a formal, case-based and mathematical approach to cross-case analysis that identifies a minimal theory, i.e., a crucial set of difference-making combinations that uniquely distinguish one group of cases with an outcome of interest from another group without that same outcome [11].

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