Qualitative evaluation to explain success of multifaceted technology-driven hypertension intervention.
Qualitative evaluation to explain success of multifaceted technology-driven hypertension intervention.
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发表时间：
2011-12
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通讯作者：
M. Millery;D. Shelley;Daren Wu;P. Ferrari;Tuo-Yen Tseng;Helene Kopal
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作者：
M. Millery;D. Shelley;Daren Wu;P. Ferrari;Tuo-Yen Tseng;Helene Kopal
目的 本研究旨在探讨基于电子健康记录的干预措施的实施情况，以提高社区卫生中心高血压护理的质量。主要目标是使用定性分析来解释干预措施的不同组成部分如何促进患者层面的积极结果。研究设计定性过程评估。方法 干预措施包括警报、订单集、模板、临床提醒算法和提供者绩效反馈。在干预之前（n = 16）和之后（n = 16）对初级保健提供者以及参与实施的关键工作人员和领导层（n = 6）进行了半结构化访谈。研究团队应用迭代系统定性编码过程来识别显着主题。 IT 实施理论的几个构建指导了分析。结果 分析的重点是：(1) 干预措施的满意度和感知有用性，(2) 感知到的干预带来的近期变化，以及 (3) 感知到的变化促进因素。不同的参与者发现不同的组件很有用。近端影响体现在多种方面（例如，更积极的随访预约和处方）以及对高血压的整体关注的增加。成功的促进因素包括领导力、组织文化、提供者参与、严格的实施流程、作为质量改进 (QI) 的干预框架以及健康中心处理数据的能力。结论 我们将干预措施的成功归功于多方面的方法，其中多种干预措施的结合导致了高血压护理实践的全面改变。与试图隔离有限的健康信息技术 (HIT) 工具影响的研究相反，我们的经验表明，如果严格实施多方面的干预措施并作为 QI 活动，HIT 可以在患者治疗方面取得成功。
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.