Patients from the VHA received higher-quality care according to a broad measure. Differences were greatest in areas where the VHA has established performance measures and actively monitors performance.

Approximately 50% of diabetic patients presenting with a substantially elevated triage blood pressure received treatment change at the visit. Clinical uncertainty about the true blood pressure value was a prominent reason that providers did not intensify therapy.

The health promotion model (HPM) was tested as a causal model of construction workers' use of hearing protection (N = 359). Theoretical and exploratory models fit well, with the theoretical model accounting for 36.3% of variance and the exploratory model accounting for 50.6% of variance in hearing protection use. Value of use (benefits of using hearing protection), barriers to use, and self-efficacy were significant predictors in both the theoretical and exploratory models, but perceived health status was a predictor only in the theoretical model. In the exploratory model, where modifying factors were allowed direct relationships with use of hearing protection, two modifying factors--noise exposure and interpersonal influences-modeling--were significant predictors. Results of this test of the HPM are consistent with the revised HPM (Pender, 1996). There were significant direct paths from modifying factors to behaviour. Use of hearing protection was best predicted by behavior-specific predictors, such as perceived barriers to use of hearing protection. Results support the use of the HPM to predict use of hearing protection.