Abstract
Pediatric palliative care (PPC) patients require years of care across professions and sectors. Sharing treatment-related information and communicating among different PPC professionals is critical to ensure good quality of care. In Germany, this communication is mostly paper-based and prone to errors. Therefore, an electronic cross-facility health record (ECHR) was participatorily designed with users, wherein information can be shared and PPC professionals can communicate with each other. As this form of electronic health record differs from existing models in Germany, there is a need for successful implementation to ensure a positive impact. Therefore, the facilitators and barriers to the implementation of ECHR in PPC were examined. Using the consolidated framework for implementation research (CFIR), transcripts of 32 interviews, 3 focus groups, and 20 think-aloud studies with PPC professionals were analyzed. CFIR indicated that the ECHR-design was viewed positively by users and can be a facilitator for implementation. Barriers exist, mainly due to the fact that the implementation is not planned, the use of the ECHR involves effort, costs are not covered, and all users must be motivated to use the ECHR for functionality. CFIR helps uncover the crux of the issues that need to be considered when planning ECHR implementation to improve care in PPC.
Highlights
This study follows the development of an electronic cross-facility health record (ECHR) in the ELSA-PP (Acronym for the German term of “ECHR for Pediatric palliative care (PPC)”) project to critically identify facilitators and barriers to ECHR implementation in advance of implementation planning
A systematic process was described to identify the facilitators and barriers based on the consolidated framework for implementation research (CFIR) to the implementation of an ECHR for PPC before implementation planning
The ECHR represents an improvement on the current situation from the perspective of the users, but there are four major challenges regarding the implementation of the ECHR: First, it could be assumed that there is a need for training on use
Summary
Pediatric palliative care (PPC) follows a holistic approach to care for children, young adults, and adolescents with life-limiting or life-shortening illnesses [1]. Care is provided for many years [2] and in sequences of treatment episodes from various inpatient and outpatient providers, such as pediatricians and general practitioners from medical offices (MO) and general outpatient PPC teams at home [3]. The general conditions of PPC patients and their relatives are variable. Support from specialist physicians, therapists, outpatient hospice services, and specialized outpatient PPC (SOPPC) teams is often necessary. It is possible to be admired in a pediatric hospice to relieve the relatives and support them
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