16
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Facilitating appropriate care delivery using electronic health record (digital health) tools is increasing. However, frequently used determinants frameworks seldom address key barriers for technology-associated implementation.

          Methods

          Semi-structured interviews were conducted in two contexts: the national Veterans Health Affairs (VA) following implementation of an electronic dashboard, a population health tool, and the Michigan Anticoagulation Quality Improvement Initiative (MAQI 2) prior to implementation of a similar electronic dashboard. The dashboard is designed for pharmacist or nurse use to monitor safe outpatient anticoagulant prescribing by physicians and other clinicians We performed rapid qualitative inquiry analysis and selected implementation strategies. Through a stakeholder focus group session, we selected implementation strategies to address determinants and facilitate implementation in the MAQI 2 sites.

          Results

          Among 45 interviewees (32 in VA, 13 in MAQI 2), we identified five key determinants of implementation success: (1) clinician authority and autonomy, (2) clinician self-identity and job satisfaction, (3) documentation and administrative needs, (4) staffing and work schedule, and (5) integration with existing information systems. Key differences between the two contexts included concerns about information technology support and prioritization within MAQI 2 (prior to implementation) but not VA (after implementation) and concerns about authority and autonomy that differed between the VA (higher baseline levels, more concerns) and MAQI 2 (lower baseline levels, less concern).

          Conclusions

          The successful implementation of electronic health record tools requires unique considerations that differ from other types of implementation, must account for the status of implementation, and should address the effects of the tool deployment on clinical staff authority and autonomy. Interviewing both post-implementation and pre-implementation users can provide a robust understanding of implementation determinants.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s43058-022-00262-w.

          Related collections

          Most cited references26

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

          Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            OUP accepted manuscript

            (2020)
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              Validation of the theoretical domains framework for use in behaviour change and implementation research

              Background An integrative theoretical framework, developed for cross-disciplinary implementation and other behaviour change research, has been applied across a wide range of clinical situations. This study tests the validity of this framework. Methods Validity was investigated by behavioural experts sorting 112 unique theoretical constructs using closed and open sort tasks. The extent of replication was tested by Discriminant Content Validation and Fuzzy Cluster Analysis. Results There was good support for a refinement of the framework comprising 14 domains of theoretical constructs (average silhouette value 0.29): ‘Knowledge’, ‘Skills’, ‘Social/Professional Role and Identity’, ‘Beliefs about Capabilities’, ‘Optimism’, ‘Beliefs about Consequences’, ‘Reinforcement’, ‘Intentions’, ‘Goals’, ‘Memory, Attention and Decision Processes’, ‘Environmental Context and Resources’, ‘Social Influences’, ‘Emotions’, and ‘Behavioural Regulation’. Conclusions The refined Theoretical Domains Framework has a strengthened empirical base and provides a method for theoretically assessing implementation problems, as well as professional and other health-related behaviours as a basis for intervention development.
                Bookmark

                Author and article information

                Contributors
                gbarnes@umich.edu
                Journal
                Implement Sci Commun
                Implement Sci Commun
                Implementation Science Communications
                BioMed Central (London )
                2662-2211
                2 February 2022
                2 February 2022
                2022
                : 3
                : 10
                Affiliations
                [1 ]GRID grid.214458.e, ISNI 0000000086837370, Frankel Cardiovascular Center, Department of Internal Medicine, , University of Michigan, ; 2800 Plymouth Rd, B14 G214, Ann Arbor, MI 48109-2800 USA
                [2 ]GRID grid.214458.e, ISNI 0000000086837370, Center for Behavioral and Social Sciences in Medicine, , University of Michigan, ; Ann Arbor, USA
                [3 ]GRID grid.214458.e, ISNI 0000000086837370, Institute for Healthcare Policy and Innovation, , University of Michigan, ; Ann Arbor, USA
                [4 ]Center for Clinical Management Research, Ann Arbor Veterans Health Affairs, Ann Arbor, USA
                [5 ]GRID grid.214458.e, ISNI 0000000086837370, Department of Learning Health Sciences, , University of Michigan, ; Ann Arbor, USA
                [6 ]GRID grid.214458.e, ISNI 0000000086837370, College of Pharmacy, , University of Michigan, ; Ann Arbor, USA
                [7 ]GRID grid.214458.e, ISNI 0000000086837370, Division of General Medicine, Department of Internal Medicine, , University of Michigan, ; Ann Arbor, USA
                Author information
                http://orcid.org/0000-0002-6532-8440
                Article
                262
                10.1186/s43058-022-00262-w
                8812192
                35109916
                15f45574-fe81-470d-8613-f40ff9ec7120
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 26 August 2021
                : 20 January 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000133, agency for healthcare research and quality;
                Award ID: R18HS026874
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                implementation,population health,anticoagulation,pharmacist

                Comments

                Comment on this article