Abstract
BackgroundEngaging health care staff in new quality improvement programs is challenging.ObjectiveWe developed 2 virtual patient (VP) avatars in the context of a clinic-level quality improvement program. We sought to determine differences in preferences for VPs and the perceived influence of interacting with the VP on clinical staff engagement with the quality improvement program.MethodsUsing a participatory design approach, we developed an older male smoker VP and a younger female smoker VP. The older male smoker was described as a patient with cardiovascular disease and was ethnically ambiguous. The female patient was younger and was worried about the impact of smoking on her pregnancy. Clinical staff were allowed to choose the VP they preferred, and the more they engaged with the VP, the more likely the VP was to quit smoking and become healthier. We deployed the VP within the context of a quality improvement program designed to encourage clinical staff to refer their patients who smoke to a patient-centered Web-assisted tobacco intervention. To evaluate the VPs, we used quantitative analyses using multivariate models of provider and practice characteristics and VP characteristic preference and analyses of a brief survey of positive deviants (clinical staff in practices with high rates of encouraging patients to use the quit smoking innovation).ResultsA total of 146 clinical staff from 76 primary care practices interacted with the VPs. Clinic staff included medical providers (35/146, 24.0%), nurse professionals (19/146, 13.0%), primary care technicians (5/146, 3.4%), managerial staff (67/146, 45.9%), and receptionists (20/146, 13.7%). Medical staff were mostly male, and other roles were mostly female. Medical providers (OR 0.031; CI 0.003-0.281; P=.002) and younger staff (OR 0.411; CI 0.177-0.952; P=.038) were less likely to choose the younger, female VP when controlling for all other characteristics. VP preference did not influence online patient referrals by staff. In high-performing practices that referred 20 or more smokers to the ePortal (13/76), the majority of clinic staff were motivated by or liked the virtual patient (20/26, 77%).ConclusionsMedical providers are more likely motivated by VPs that are similar to their patient population, while nurses and other staff may prefer avatars that are more similar to them.
Highlights
Engaging clinical staff in quality improvement interventions that promote clinical staff-patient discussions and referrals to health behavior change resources is key for health promotion, disease prevention, and disease management [1]
Web technology use by primary care staff varied by staff role, with medical providers having the highest use of technology and patient care technicians having the lowest (Table 1)
We found distinct virtual patient (VP) preferences mediated by clinical staff characteristics and positive impressions of VPs as agents to engage staff in quality improvement, preference for individual VP did not influence participation in the quality improvement program
Summary
Engaging clinical staff in quality improvement interventions that promote clinical staff-patient discussions and referrals to health behavior change resources is key for health promotion, disease prevention, and disease management [1]. Interdisciplinary medical teams in the health care setting work collaboratively to provide comprehensive health services [2] These teams commonly include medical providers, nurse professionals, patient care technicians, social workers [3], and increasingly include administrative staff for enhanced communication within and between clinical teams [4]. Interventions are targeted to motivate clinical teams to engage patients in health-promoting behaviors [5]. Techniques to motivate physicians, nurses, and primary care staff to encourage patient health-promoting behaviors traditionally include reminders and performance feedback [6,7]. While these techniques are successful in the short term, they do not provide continuous reminders to cue behavior or sustainably engage providers for the long term. Engaging health care staff in new quality improvement programs is challenging
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