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The Association of Hospital Characteristics and Quality Improvement Activities in Inpatient Medical Services

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ABSTRACT

BACKGROUND

Quality of U.S. health care has been the focus of increasing attention, with deficiencies in patient care well recognized and documented. However, relatively little is known about the extent to which hospitals engage in quality improvement activities (QIAs) or factors influencing extent of QIAs.

OBJECTIVE

To identify 1) the extent of QIAs in Veterans Administration (VA) inpatient medical services; and 2) factors associated with widespread adoption of QIAs, in particular use of hospitalists, non-physician providers, and extent of goal alignment between the inpatient service and senior managers on commitment to quality.

DESIGN

Cross-sectional, descriptive study of QIAs using a survey administered to Chiefs of Medicine (COM) at all 124 VA acute care hospitals. We conducted hierarchical regression, regressing QIA use on facility contextual variables, followed by use of hospitalists, non-physician providers, and goal alignment/quality commitment.

MAIN MEASURES

Outcome measures pertained to use of a set of 27 QIAs and to three dimensions—infrastructure, prevention, and information gathering—that were identified by factor analysis among the 27 QIAs overall.

KEY RESULTS

Survey response rate was 90 % (111/124). Goal alignment/quality commitment was associated with more widespread use of all four QIA categories [infrastructure (b = 0.42; p < 0.001); prevention (b = 0.24; p < 0.001); information gathering (b = 0.28; p = <0.001); and overall QIA (b = 0.31; p < 0.001)], as was greater use of hospitalists [infrastructure (b = 0.55; p = 0.03); prevention (b = 0.61; p < 0.001); information gathering (b = 0.75; p = 0.01); and overall QIAs (b = 0.61; p < 0.001)]; higher occupancy rate was associated with greater infrastructure QIAs (b = 1.05, p = 0.02). Non-physician provider use, hospital size, university affiliation, and geographic region were not associated with QIAs.

CONCLUSION

As hospitals respond to changes in healthcare (e.g., pay for performance, accountable care organizations), this study suggests that practices such as use of hospitalists and leadership focus on goal alignment/quality commitment may lead to greater implementation of QIAs.

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Acknowledgements

The work reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (REA 09-220), and the Comprehensive Access & Delivery Research and Evaluation (CADRE) Center at the Iowa City VAMC (HFP 04-149) and the Center for Organizational Leadership and Management Research (COLMR) at the Boston VA Healthcare System (HFP 04-145). We acknowledge and appreciate the intellectual contribution made by Dr. Alan Cohen, Dr. Michael Shwartz and Jed Horwitt who, along with Dr. Restuccia, developed the Quality Improvement Activities Survey from which many of the questions in our survey were drawn. We also wish to thank Dr. Caitlin Brennan and Dr. James Burgess for their careful review of the manuscript and insightful comments. Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Center for Organizational Leadership and Management Research (COLMR), Boston VA Healthcare System, Boston, MA, USA

    Joseph D. Restuccia Dr, PH, David Mohr PhD, Mark Meterko PhD & Kelly Stolzmann MS

  2. Boston University School of Management, Boston, MA, USA

    Joseph D. Restuccia Dr, PH

  3. Boston University School of Public Health, Boston, MA, USA

    Mark Meterko PhD

  4. The Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Healthcare System, Iowa City, IA, USA

    Peter Kaboli MD, MS

  5. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Peter Kaboli MD, MS

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  1. Joseph D. Restuccia Dr, PH
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Correspondence to Joseph D. Restuccia Dr, PH.

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Restuccia, J.D., Mohr, D., Meterko, M. et al. The Association of Hospital Characteristics and Quality Improvement Activities in Inpatient Medical Services. J GEN INTERN MED 29, 715–722 (2014). https://doi.org/10.1007/s11606-013-2759-8

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  • DOI: https://doi.org/10.1007/s11606-013-2759-8

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