1. Assess usage and satisfaction with HIV Clinical Reminders (CR) and VA HIV Collaborative as modified based on previous QuERI HIV findings2. Elicit user suggestions for improvement of the interventions.3. Identify features that promote and inhibit adoption.
Surveys with scale-based and open-ended questions were used. HIV CR users were asked to rate frequency of usage and usefulness in practice of each CR and to suggest potential improvements. HIV Collaborative participants were asked to rate helpfulness of elements of the intervention and impact on care quality and job satisfaction.
The HIV CR survey was sent electronically to users at 37 facilities that had received HIV CRs in the previous QuERI project or requested them since December 2002; 19 responses representing 14 facilities (38% RR) were received. Frequency and type of use varied among the HIV CRs and across facilities. Frequencies of use and usefulness ratings were loosely but not consistently correlated. Comments revealed lack of familiarity with the function of the CR system itself and with some of the features of the HIV CRs. Improvement suggestions validated much of the findings from the previous QuERI human factors evaluation. The Collaborative survey completed following the third and final group meeting (n=19) revealed high ratings of the impact and value of the project, with mean ratings of 4.89 (out of 5) for positive impact on care quality and 4.95 for recommending Collaborative participation to colleagues. The strongest factors contributing to the high ratings were the opportunity for focused networking and collegial exchange with other VA clinicians involved in HIV care and learning an efficient model to organize care quality improvement activities.
Availability of HIV CRs at a facility does not correlate with actual use. Ongoing coaching and technical support is required to accommodate local variation. Users suggested several new topics for HIV CRs. The Collaborative model was well rated, and participants reported better use of electronic tools such as CRs. Linkage of provider rating and impact on clinical outcomes is warranted.