在初级保健中实施癌症预防临床决策支持的障碍和促进因素：一项定性研究。
Barriers and facilitators to implementing cancer prevention clinical decision support in primary care: a qualitative study.
机构信息
Essentia Institute of Rural Health, 502 East Second Street, Duluth, MN, 55805, USA.
HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA.
出版信息
BMC Health Serv Res. 2019 Jul 31;19(1):534. doi: 10.1186/s12913-019-4326-4.
BACKGROUND
In the United States, primary care providers (PCPs) routinely balance acute, chronic, and preventive patient care delivery, including cancer prevention and screening, in time-limited visits. Clinical decision support (CDS) may help PCPs prioritize cancer prevention and screening with other patient needs. In a three-arm, pragmatic, clinic-randomized control trial, we are studying cancer prevention CDS in a large, upper Midwestern healthcare system. The web-based, electronic health record (EHR)-linked CDS integrates evidence-based primary and secondary cancer prevention and screening recommendations into an existing cardiovascular risk management CDS system. Our objective with this study was to identify adoption barriers and facilitators before implementation in primary care.
METHODS
We conducted semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) with 28 key informants employed by the healthcare organization in either leadership roles or the direct provision of clinical care. Transcribed interviews were analyzed using qualitative content analysis.
RESULTS
EHR, CDS workflow, CDS users (providers and patients), training, and organizational barriers and facilitators were identified related to Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals CFIR domains.
CONCLUSION
Identifying and addressing key informant-identified barriers and facilitators before implementing cancer prevention CDS in primary care may support a successful implementation and sustained use. The CFIR is a useful framework for understanding pre-implementation barriers and facilitators. Based on our findings, the research team developed and instituted specialized training, pilot testing, implementation plans, and post-implementation efforts to maximize identified facilitators and address barriers.
TRIAL REGISTRATION
clinicaltrials.gov , NCT02986230 , December 6, 2016.
背景
在美国，初级保健提供者（PCP）通常在有限的时间内平衡急性、慢性和预防患者的医疗服务，包括癌症预防和筛查。临床决策支持（CDS）可以帮助 PCP 在其他患者需求的基础上优先考虑癌症预防和筛查。在一项三臂、实用、诊所随机对照试验中，我们正在一个大型中西部医疗保健系统中研究癌症预防 CDS。基于网络的、与电子健康记录（EHR）链接的 CDS 将基于证据的初级和二级癌症预防和筛查建议整合到现有的心血管风险管理 CDS 系统中。我们这项研究的目的是在初级保健中实施之前确定采用的障碍和促进因素。
方法
我们对 28 名关键信息提供者进行了半结构化访谈，这些信息提供者在医疗保健组织中担任领导职务或直接提供临床护理，他们的工作受到了电子病历（EHR）、CDS 工作流程、CDS 用户（提供者和患者）、培训以及组织障碍和促进因素的影响。使用定性内容分析对转录后的访谈进行分析。
结果
EHR、CDS 工作流程、CDS 用户（提供者和患者）、培训以及组织障碍和促进因素与干预特征、外部环境、内部环境和个人 CFIR 领域的特征有关。
结论
在初级保健中实施癌症预防 CDS 之前，确定并解决关键信息提供者确定的障碍和促进因素可能会支持成功的实施和持续使用。CFIR 是理解实施前障碍和促进因素的有用框架。根据我们的发现，研究团队制定并实施了专门的培训、试点测试、实施计划和实施后工作，以最大限度地提高确定的促进因素并解决障碍。
试验注册
clinicaltrials.gov，NCT02986230，2016 年 12 月 6 日。
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