J Healthc Qual. 2020 May/Jun;42(3):148-156. doi: 10.1097/JHQ.0000000000000217.
The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. To date, there has been scant research on how VHA adopts clinical preventive services guidelines and how U.S. Preventive Services Task Force recommendations factor into the process.
Researchers conducted semistructured interviews with eight VHA leaders to examine how they adopt, disseminate, and measure adherence to recommendations. Interviews were recorded, transcribed, and aggregated into a database to enable sorting and synthesis. Themes were identified across the key informant interviews.
The development of VHA clinical prevention guidelines is coordinated by the National Center for Health Promotion and Disease Prevention. A VHA Advisory Committee discusses and votes to approve or disapprove each guideline. Several factors can impact the ability of a veterans affairs medical center to implement a guideline, such as local system capacity and priorities for quality improvement. Methods to promote implementation include electronic reminders, educational events, and a robust performance measurement system.
Provision of evidence-based clinical preventive services is an important part of VHA's effort to provide high-quality care for Veterans. Recent achievements in lung cancer, colorectal cancer, and Hepatitis C screening highlight VHA's successful approach to implementation of preventive services guidance.
退伍军人健康管理局（VHA）是美国最大的综合性医疗保健系统。迄今为止，关于 VHA 如何采用临床预防服务指南以及美国预防服务工作组的建议如何融入这一过程的研究甚少。
研究人员对 8 名 VHA 领导人进行了半结构化访谈，以研究他们如何采用、传播和衡量对建议的遵守情况。访谈进行了录音、转录，并汇总到一个数据库中，以便进行分类和综合。在关键知情人访谈中确定了主题。
VHA 临床预防指南的制定由国家健康促进和疾病预防中心协调。VHA 咨询委员会讨论并投票批准或否决每项指南。一些因素可能会影响退伍军人事务医疗中心实施指南的能力，例如当地系统的能力和质量改进的优先事项。促进实施的方法包括电子提醒、教育活动和强大的绩效衡量系统。
提供基于证据的临床预防服务是 VHA 为退伍军人提供高质量护理的努力的重要组成部分。最近在肺癌、结直肠癌和丙型肝炎筛查方面取得的成就突显了 VHA 在实施预防服务指南方面的成功方法。
