David A. Dorr (
Deborah J. Cohen is a professor of family medicine at Oregon Health & Science University.
Health Aff (Millwood). 2018 Feb;37(2):257-265. doi: 10.1377/hlthaff.2017.1133.
Failed diffusion of innovations may be linked to an inability to use and apply data, information, and knowledge to change perceptions of current practice and motivate change. Using qualitative and quantitative data from three large-scale health care delivery innovations-accountable care organizations, advanced primary care practice, and EvidenceNOW-we assessed where data-driven innovation is occurring and where challenges lie. We found that implementation of some technological components of innovation (for example, electronic health records) has occurred among health care organizations, but core functions needed to use data to drive innovation are lacking. Deficits include the inability to extract and aggregate data from the records; gaps in sharing data; and challenges in adopting advanced data functions, particularly those related to timely reporting of performance data. The unexpectedly high costs and burden incurred during implementation of the innovations have limited organizations' ability to address these and other deficits. Solutions that could help speed progress in data-driven innovation include facilitating peer-to-peer technical assistance, providing tailored feedback reports to providers from data aggregators, and using practice facilitators skilled in using data technology for quality improvement to help practices transform. Policy efforts that promote these solutions may enable more rapid uptake of and successful participation in innovative delivery system reforms.
创新扩散失败可能与无法利用和应用数据、信息和知识来改变对当前实践的看法以及激励变革的能力有关。我们使用来自三项大型医疗保健服务创新(责任医疗组织、高级初级保健实践和 EvidenceNOW)的定性和定量数据,评估了数据驱动创新正在发生的地方和存在挑战的地方。我们发现,一些创新的技术组成部分(例如电子健康记录)已经在医疗机构中实施,但缺乏利用数据推动创新所需的核心功能。缺陷包括无法从记录中提取和汇总数据;数据共享存在差距;以及采用先进的数据功能(特别是与及时报告绩效数据相关的功能)方面面临挑战。创新实施过程中出乎意料的高成本和负担限制了各组织解决这些和其他缺陷的能力。有助于加快数据驱动创新的解决方案包括促进同行间的技术援助、为数据聚合器向提供者提供定制的反馈报告、以及利用熟练使用数据技术进行质量改进的实践促进者来帮助实践转型。促进这些解决方案的政策努力可能会使更多的人更快地采用和成功参与创新的交付系统改革。