OBJECTIVES: This study sought to examine the implementation of an electronic health record-based intervention to improve quality of hypertension care in community health centers. The primary goal was to use qualitative analysis to explain how different components of the intervention contributed to positive patient-level outcomes. STUDY DESIGN: Qualitative process evaluation. METHODS: The intervention included alerts, order sets, templates, clinical reminder algorithms, and provider performance feedback. Semi-structured interviews were conducted with primary care providers before (n = 16) and after (n = 16) intervention, and with key staff and leadership involved in the implementation (n = 6). The research team applied an iterative systematic qualitative coding process to identify salient themes. Several constructs from IT implementation theories guided the analysis. RESULTS: The analysis focused on: (1) satisfaction and perceived usefulness of intervention components, (2) perceived proximal changes resulting from intervention, and (3) perceived facilitators of change. Different participants found different components useful. Proximal impact manifested in multiple ways (eg, more aggressive follow-up appointments and prescribing) and in increased overall attention to hypertension. Facilitators of success included leadership, organizational culture, provider engagement, rigorous implementation process, framing of intervention as quality improvement (QI), and health center capacity to process data. CONCLUSIONS: We attribute the success of the intervention to a multifaceted approach where the combination of multiple intervention components resulted in across the-board change in hypertension care practices. In contrast with research that attempts to isolate the impact of circumscribed health information technology (HIT) tools, our experience suggests that HIT can achieve success in patient outcomes when rigorously implemented as a multifaceted intervention and framed as QI activity.
OBJECTIVES: This study sought to examine the implementation of an electronic health record-based intervention to improve quality of hypertension care in community health centers. The primary goal was to use qualitative analysis to explain how different components of the intervention contributed to positive patient-level outcomes. STUDY DESIGN: Qualitative process evaluation. METHODS: The intervention included alerts, order sets, templates, clinical reminder algorithms, and provider performance feedback. Semi-structured interviews were conducted with primary care providers before (n = 16) and after (n = 16) intervention, and with key staff and leadership involved in the implementation (n = 6). The research team applied an iterative systematic qualitative coding process to identify salient themes. Several constructs from IT implementation theories guided the analysis. RESULTS: The analysis focused on: (1) satisfaction and perceived usefulness of intervention components, (2) perceived proximal changes resulting from intervention, and (3) perceived facilitators of change. Different participants found different components useful. Proximal impact manifested in multiple ways (eg, more aggressive follow-up appointments and prescribing) and in increased overall attention to hypertension. Facilitators of success included leadership, organizational culture, provider engagement, rigorous implementation process, framing of intervention as quality improvement (QI), and health center capacity to process data. CONCLUSIONS: We attribute the success of the intervention to a multifaceted approach where the combination of multiple intervention components resulted in across the-board change in hypertension care practices. In contrast with research that attempts to isolate the impact of circumscribed health information technology (HIT) tools, our experience suggests that HIT can achieve success in patient outcomes when rigorously implemented as a multifaceted intervention and framed as QI activity.
Authors: Emily C Williams; Carol E Achtmeyer; Rachel M Thomas; Joel R Grossbard; Gwen T Lapham; Laura J Chavez; Evette J Ludman; Douglas Berger; Katharine A Bradley Journal: J Gen Intern Med Date: 2015-03-03 Impact factor: 5.128
Authors: Mary E Northridge; Shirley Birenz; Danni M Gomes; Cynthia A Golembeski; Ariel Port Greenblatt; Donna Shelley; Stefanie L Russell Journal: J Dent Hyg Date: 2016-06
Authors: Alison J O'Donnell; Hillary R Bogner; Peter F Cronholm; Katherine Kellom; Michelle Miller-Day; Heather F de Vries McClintock; Elise M Kaye; Robert Gabbay Journal: Prev Chronic Dis Date: 2016-02-25 Impact factor: 2.830
Authors: Ramya Sita Palacholla; Nils Fischer; Amanda Coleman; Stephen Agboola; Katherine Kirley; Jennifer Felsted; Chelsea Katz; Stacy Lloyd; Kamal Jethwani Journal: JMIR Cardio Date: 2019-03-26