Synthesizing Lessons Learned Using Health Information Technology

描述（由申请人提供）：在过去的十年中，实践合作伙伴研究网络（PPRNet）已经建立了一个理论知情框架，用于在使用实践合作伙伴(R) （McKesson Corporation, Seattle， WA）电子病历（EMR）的中小型初级保健实践中将研究转化为实践（TRIP）。PPRNet-TRIP质量改进（QI）模型有三个组成部分：干预模型、改进模型和帮助实践实施质量改进（QI）的实践发展模型。使用PPRNet-TRIP QI模型，这个基于实践的研究网络（PBRN）指导其成员实践，以提高一套健全的初级保健措施的质量。PPRNet-TRIP QI的干预模式通过结合绩效报告、实地考察和网络会议在实践环境中实施。改进模型的重点是优先考虑绩效、让所有员工参与、重新设计交付系统、患者激活和使用电子病历工具。实践发展模型通过七个概念帮助实践理解和实施QI：领导者设定具有明确目标的愿景；让团队参与；加强通讯系统；发展团队；采取小步骤；吸收电子病历，以最大限度地提高临床疗效；并在改进的文化中提供反馈，导致领导者设定目标的迭代循环。本研究旨在探讨利用医疗资讯科技（HIT）改善医疗照护决策，方法是评估使用电子病历时如何改善照护品质，以及如何在实务设置中增加新角色的采用，以改善病患与医疗照护实务之间的沟通。这个为期两年的项目的具体目标是：1)完成一项混合方法的二次分析，以综合七个国家资助的PPRNet倡议中与提高初级保健中使用HIT的质量有关的发现。2)检查PPRNet-TRIP研究实践参与者在以下方面的当前观点：发展和维持QI努力；以及团队发展，通过稳健的电子病历实施，发挥越来越积极的医疗保健服务作用。3)将PPRNet以往的研究成果与实践代表的当前观点相结合，完善以理论为基础的总体“PPRNet- trip QI模型”。拟议的R03的目标和产品将进一步实现通过使用HIT来提高现实世界初级保健实践的绩效，为所有美国人提供安全、高效和有效的医疗保健的目标。

DESCRIPTION (provided by applicant): During the past decade, Practice Partner Research Network (PPRNet) has established a theoretically-informed framework for translating research into practice (TRIP) within small to medium sized primary care practices that use the Practice Partner(R) (McKesson Corporation, Seattle, WA) electronic medical record (EMR). The PPRNet-TRIP Quality Improvement (QI) Model features three components: an intervention model, an improvement model and a practice development model that assists practices with implementation of quality improvement (QI). Using the PPRNet-TRIP QI Model this practice-based research network (PBRN) guided its' member practices to improve quality on a robust set of primary care measures. PPRNet-TRIP QI's intervention model is implemented in practice settings through a combination of performance reports, site visits, and network meetings. The improvement model focuses on prioritizing performance, involving all staff, redesigning the delivery system, patient activation, and using EMR tools. The practice development model helps practices understand and implement QI using seven concepts: leaders setting a vision with clear goals; involving the team; enhancing communication systems; developing the team; taking small steps; assimilating the EMR to maximize clinical effectiveness; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting by leaders. This proposed research addresses the use of health information technology (HIT) to improve health care decision-making by evaluating how quality of care is improved while using EMRs, and how to increase the adoption of new roles in practice settings to improve communication between patients and practices about health care. The specific aims of this two year project are to: 1) Complete a mixed methods secondary analysis to synthesize findings related to improving quality using HIT in primary care across seven nationally funded PPRNet initiatives. 2) Examine current perspectives of PPRNet-TRIP study practice participants related to: developing and sustaining QI efforts; and team development for an increasingly more active health care delivery role through robust EMR implementation. 3) Integrate findings from PPRNet's previous studies with the current perspectives of practice representatives to refine the overarching theory-based "PPRNet-TRIP QI Model". The aims and products of the proposed R03 will further the goals of supporting safe, efficient and effective health care for all Americans through use of HIT to improve performance in real world of primary care practices. PUBLIC HEALTH RELEVANCE: NARRATIVE - Coherent conceptual frameworks are needed to activate practices that aim to improve the delivery of primary care using their electronic medical records. The Practice Partner Research Network has used an internally developed conceptual framework for improving quality on a robust set of quality indicators. A systematic secondary analysis and synthesis of quality improvement sustainability and maintenance will provide evidence for refining the well-developed and useful PPRNet-TRIP QI model.