Using Lean-Facilitation to Improve Quality of Hepatitis C Testing in Primary Care
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Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers VA Medical Center, Bedford, MA, USA; 2Office of Healthcare Transformation, Department of Veterans Affairs, Washington, DC, USA; 3Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA; 4Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; 5Department of Health Law Policy & Management, Boston University School of Public Health, Boston, MA, USA; 6VA Boston Healthcare System, West Roxbury, MA, USA.
BACKGROUND: Lean management has been successfully employed in healthcare to improve outcomes and efficiencies. Facilitation is increasingly being used to support evidence-based practice uptake in healthcare. However, while both Lean and Facilitation are used in healthcare quality improvement, limited research has explored their integration and the sustainability of their combined effects. OBJECTIVE: To improve hepatitis C virus (HCV) screening rates among persons born between 1945 and 1965 through the design and evaluation of a multi-modal LeanFacilitation intervention (LFI) for Department of Veterans Affairs primary care community clinics. DESIGN: We conducted a mixed methods quasiexperimental evaluation in eight clinics, guided by the integrated Promoting Action on Research Implementation in Health Services framework. PARTICIPANTS: We engaged regional and local leadership (N = 9), implemented our LFI with clinicians and staff (N = 68), and conducted summative interviews with participants (N = 13). INTERVENTION: The LFI included six implementation strategies: (1) external facilitation, (2) stakeholder engagement, (3) champion activation, (4) rapid process improvement sessions, (5) Plan-Do-Study-Act cycles, and (6) audit-feedback. MEASURES: The primary outcome was rate of new HCV screening among previously untested patients with a primary care visit. Using interrupted time series, we analyzed intervention and time effects on HCV testing rates, and administered organizational readiness surveys, conducted summative qualitative interviews, and tracked facilitation events. RESULTS: The LFI was associated with significant, immediate, and sustained increases in HCV testing. No
Prior Presentations Preliminary findings were presented at the 2016 Conference on the Science of Dissemination and Implementation, titled “Applying Lean Principles to Improve Hepatitis C Testing in VA Primary Care Community Clinics.” Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06210-5) contains supplementary material, which is available to authorized users. Received September 3, 2019 Accepted September 1, 2020
change was detected at matched comparison clinics. Staff accepted the LFI and the philosophy of “bottom-up” solution development yet had mixed feedback on its appropriateness and feasibility. Enablers of implementation and early sustainment included lower satisfaction with baseline HCV
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