Abstract
BackgroundIn this paper we describe the use of the Consolidated Framework for Implementation Research (CFIR) to study implementation of a web-based, point-of-care, EHR-linked clinical decision support (CDS) tool designed to identify and provide care recommendations for adults with prediabetes (Pre-D CDS).MethodsAs part of a large NIH-funded clinic-randomized trial, we identified a convenience sample of interview participants from 22 primary care clinics in Minnesota, North Dakota, and Wisconsin that were randomly allocated to receive or not receive a web-based EHR-integrated prediabetes CDS intervention. Participants included 11 clinicians, 6 rooming staff, and 7 nurse or clinic managers recruited by study staff to participate in telephone interviews conducted by an expert in qualitative methods. Interviews were recorded and transcribed, and data analysis was conducted using a constructivist version of grounded theory.ResultsImplementing a prediabetes CDS tool into primary care clinics was useful and well received. The intervention was integrated with clinic workflows, supported primary care clinicians in clearly communicating prediabetes risk and management options with patients, and in identifying actionable care opportunities. The main barriers to CDS use were time and competing priorities. Finally, while the implementation process worked well, opportunities remain in engaging the care team more broadly in CDS use.ConclusionsThe use of CDS tools for engaging patients and providers in care improvement opportunities for prediabetes is a promising and potentially effective strategy in primary care settings. A workflow that incorporates the whole care team in the use of such tools may optimize the implementation of CDS tools like these in primary care settings.Trial registration Name of the registry: Clinicaltrial.gov. Trial registration number: NCT02759055. Date of registration: 05/03/2016. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT02759055 Prospectively registered.
Highlights
In this paper we describe the use of the Consolidated Framework for Implementation Research (CFIR) to study implementation of a web-based, point-of-care, electronic health record (EHR)-linked clinical decision support (CDS) tool designed to identify and provide care recommendations for adults with prediabetes (Pre-D CDS)
The primary care clinics ranged in size from 3 to 25 Primary care clinicians (PCC) based in rural, small town, micropolitan, and metropolitan commuting areas
Here we present the findings of the analysis, with the main themes organized by the CFIR constructs of intervention characteristics, inner setting and process, and their associated sub-themes
Summary
In this paper we describe the use of the Consolidated Framework for Implementation Research (CFIR) to study implementation of a web-based, point-of-care, EHR-linked clinical decision support (CDS) tool designed to identify and provide care recommendations for adults with prediabetes (Pre-D CDS). Interventions for prediabetes through exercise, diet, weight loss, and targeted pharmacotherapy can prevent or delay progression to diabetes and decrease rates of cardiovascular events [2]. Primary care clinicians (PCCs) are well placed to engage patients in these interventions [3,4,5]. Despite frequent contact between PCCs and patients at risk for diabetes, there are frequent missed opportunities to discuss and address that risk [6, 7]. More research is needed to find more consistent ways to identify and manage prediabetes in primary care practices and real world settings [11], to ensure patients receive information they need about opportunities to reduce their risk
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