Healthcare Inspection Evaluation of Community Based Outpatient Clinics Fiscal Year 2010

The purpose was to evaluate selected activities, assessing whether the community based outpatient clinics (CBOCs) are operated in a manner that provides veterans with consistent, safe, high-quality health care. CBOCs overall appear to be providing a quality of care that is not substantially different from parent VA medical centers. The CBOCs generally met Veterans Health Administration (VHA) directives and guidelines. Overall, we found no statistically significant differences between VA-staffed and contract CBOCs performance measure estimated compliance rates. However, estimated VA CBOC compliance rates were slightly higher in VA-staffed CBOCs than in contract CBOCs. Rural contract CBOCs had a higher mean compliance rate than VA-staffed CBOCs, and urban CBOCs average compliance rates were higher for VA-staffed; but, neither was statistically significant. We found the following areas that needed improvement. We found that (a) only 41 (87 percent) of 47 CBOCs complied with the required cardiopulmonary resuscitation training; (b) 12 (26 percent) of the 47 CBOCs did not monitor, collect, or analyze hand hygiene data on a routine basis; (c) 9 (19 percent) CBOCs did not consistently secure patients’ personal identifiable information (PII); (d) VHA used 4 different pricing models to compensate for mental health (MH) services at the 18 contract CBOCs; and (e) Primary Care Management Module (PCMM) Coordinators were not effectively managing primary care provider (PCP) assignments, which resulted in 9 (50 percent) of 18 contract CBOCs having patients assigned to more than one PCP. To improve operations, we recommended that the Under Secretary for Health, in conjunction with Veterans Integrated Service Network and facility senior managers: (1) emphasize the requirements to define staff that need life support training, systematically track training status, and take appropriate action when training is not maintained; (2) monitor, collect, and analyze hand hygiene data; (3) secure and protect patients’ PII; (4) review MH pricing models to determine the most effective compensation for MH services to be implemented in CBOC contracts; and (5) ensure that the PCMM is effectively managed by the Facility Director in conjunction with the PCMM Coordinator to minimize the assignment of patients to more than one PCP.