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Organizational Factors Driving Selection of Gastrointestinal Endoscopic Sedation in Veterans Health Administration
Megan A Adams1,2,3, Joel H Rubenstein1,2,3, Jane H Forman1
1Center for Clinical Management Research, Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
Introduction:
Previous studies suggest that unmeasured organizational factors drive variability in anesthesia-assisted sedation (AA) use.
Methods:
A mixed-methods study of 11 Veterans Health Administration and community gastrointestinal endoscopy sites; qualitative interviews of key sedation decision-makers.
Results:
Three key interview themes were identified: (i) Increased AA demand and changes in endoscopist sedation training in fellowship drove site-level AA capacity expansion; (ii) this expansion further influenced sedation decisions in favor of AA use; and (iii) additional organizational factors influencing AA use included site-level decision-making processes and differences between Veterans Health Administration and community practice economics/mission.
Discussion:
Key organizational factors drive variability in AA use across settings.
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