Geriatric Research, Education, and Clinical Center, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah 84148, USA.
J Am Med Inform Assoc. 2011 Nov-Dec;18(6):827-34. doi: 10.1136/amiajnl-2010-000076. Epub 2011 May 12.
The evidence base for information technology (IT) has been criticized, especially with the current emphasis on translational science. The purpose of this paper is to present an analysis of the role of IT in the implementation of a geriatric education and quality improvement (QI) intervention.
A mixed-method three-group comparative design was used. The PRECEDE/PROCEED implementation model was used to qualitatively identify key factors in the implementation process. These results were further explored in a quantitative analysis.
Thirty-three primary care clinics at three institutions (Intermountain Healthcare, VA Salt Lake City Health Care System, and University of Utah) participated. The program consisted of an onsite, didactic session, QI planning and 6 months of intense implementation support.
Completion rate was 82% with an average improvement rate of 21%. Important predisposing factors for success included an established electronic record and a culture of quality. The reinforcing and enabling factors included free continuing medical education credits, feedback, IT access, and flexible support. The relationship between IT and QI emerged as a central factor. Quantitative analysis found significant differences between institutions for pre-post changes even after the number and category of implementation strategies had been controlled for.
The analysis illustrates the complex dependence between IT interventions, institutional characteristics, and implementation practices. Access to IT tools and data by individual clinicians may be a key factor for the success of QI projects. Institutions vary widely in the degree of access to IT tools and support. This article suggests that more attention be paid to the QI and IT department relationship.
信息技术（IT）的证据基础受到了批评，尤其是在当前强调转化科学的情况下。本文旨在分析 IT 在实施老年医学教育和质量改进（QI）干预中的作用。
采用混合方法三组比较设计。PRECEDE/PROCEED 实施模型用于定性识别实施过程中的关键因素。这些结果在定量分析中进一步探讨。
33 家医疗机构（Intermountain Healthcare、VA Salt Lake City Health Care System 和 University of Utah）的 33 个初级保健诊所参与了该计划。该计划包括现场的讲座、QI 规划和 6 个月的密集实施支持。
完成率为 82%，平均改进率为 21%。成功的重要前置因素包括已建立的电子记录和质量文化。强化和支持因素包括免费继续医学教育学分、反馈、IT 访问和灵活的支持。IT 和 QI 之间的关系是一个核心因素。即使在控制了实施策略的数量和类别后，定量分析仍发现了机构之间的显著差异。
分析说明了 IT 干预、机构特征和实施实践之间的复杂依存关系。临床医生个人获得 IT 工具和数据的机会可能是 QI 项目成功的关键因素。各机构在 IT 工具和支持的获取程度上存在很大差异。本文建议更多关注 QI 和 IT 部门的关系。
