Article Figures & Data
Figures
- Figure 1.
Steps used to identify evidence-based interventions from Group Health 2013 publications. *From database of peer-reviewed publications in 2013 by Group Health Research Institute–affiliated researchers; **This number worked best with the configuration of the practice-based research network's annual meeting; depending on a group's objectives, a larger or smaller number could be selected. WPRN, WWAMI region Practice and Research Network.
Tables
- Table 1.
Innovations Identified from 2013 Group Health Publications and Reviewed by 26 WWAMI Region Practice and Research Network Clinicians Using the Decision-to-Implement Worksheet
Innovation Description Discussion Comments Ask-Advise-Connect (AAC)21 Active quitline referral: licensed vocational nurses assess and record the smoking status of all patients in the electronic health record. The names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas quitline daily. Patients were proactively called by the quitline within 48 hours. “Easier than stocking brochures; don't have to worry about follow-up.”
“How would you assess return on investment/what is cost to clinic?”
“Helps prompt universal screening for tobacco use.”Electronic Communications and Home Blood Pressure Monitoring to Improve Blood Pressure Control (e-BP)22 Patients with uncontrolled BP were registered to use an existing shared patient electronic health record and secure E-mail and randomly assigned to (1) usual care; (2) home BP monitoring and website training; or (3) this plus pharmacist-led team care delivered via the Web. “Outcomes for hypertension were improved but not necessarily in [a] cost-effective manner.”
“Patient portal [is] helpful but not all patients have access to patient portal or Internet.”
“Would think about implementing but barriers include reimbursement model, reduced office visits, available staff; might be adaptable with cheaper personnel.”Guide to Decide (GtD)20 Website that walked women at high risk of breast cancer through 2 medical options to prevent breast cancer: tamoxifen and raloxifene. Information was tailored to each woman's age and race. “We have so many other battles to fight, more prevalent battles, this is more like Mercedes intervention compared to our population which merely needs bus ticket.”
“Important, but low on priority list compared to revenue-generating activities.”TEAMcare23 A collaborative approach to care for patients with depression and physical diseases in which nurse care managers monitor disease control and depression; work with patients and their primary care providers to set clinical and self-management goals and adjust medications; consult weekly with psychiatrists. “Patient literacy could be a problem.”
“How would reimbursement work?”
“Staff could be trained to do this.”
“Would federally qualified health center leadership buy in?”BP, blood pressure.
Item Domain* Intervention Correlation With Likelihood of Implementation (P Value) Ask-Advise-Connect (AAC)21 Electronic Communications and Home Blood Pressure Monitoring to Improve Blood Pressure Control (e-BP)22 Guide to Decide (GtD)20 TEAMcare23 Participants (n) 7 6 7 6 Agree or strongly agree that this intervention is: Described clearly Simplicity 100% 100% 100% 83% −.186 (.363) Addressing a common or high priority problem in my practice Compatibility 100% 100% 43%† 100% −0.401 (.052) Simple to implement in my practice Simplicity 86%‡ 17%§ 29%§ 33% −0.634 (.001) An improvement to the current way of doing things in my practice Relative advantage 86%‡ 67%§ 71%§ 67%† −0.084 (.716) Something I could test in my practice prior to fully implementing Trialability 71%†§ 83% 43%† 67%§ −0.519 (.016) Conducted in a setting similar to my practice Compatibility 29%†‡ 83% 43%† 17%§ −0.232 (.325) Relevant to my patient population Compatibility 86%‡ 83% 29%¶ 67% −0.281 (.205) Modifiable to meet the needs of my practice Trialability 71%‡§ 100% 43%¶ 83% −0.478 (.028) Level of practice resources needed to implement this intervention (scale: 1 = low, 4 = high) Additional training for practice staff Compatibility 2.5‡ 3 3 3 −0.338 (.098) Changes to workflow, roles and tasks among team members Compatibility 3‡ 3 3 4 −0.191 (.359) Technical assistance to modify the EMR or data systems Compatibility 3‡ 3 4§ 2 −0.145 (.498) New and/or additional financial investment/support Compatibility 2‡ 3.5 2‖ 2.5 −0.366 (.103) Support from practice/clinic leadership Compatibility 2.5‡ 3 4 3 −0.227 (.276) Likelihood of implementation (scale 1 = low, 5 = high) Median 3.5‡ 2.5 2 2.5 Range 3–4 2–4 1–3 2–5 ↵* Domains ask the following questions (per Rogers18): relative advantage, “Is the innovation better than what was there before?”; compatibility, “Does the innovation fit with the intended audience, setting, and available resources?”; complexity, “Is the innovation easy to use?”; trialability, “Can the innovation be tried before making a decision to adopt?”; and observability, “Are the results of the innovation visible and easily measurable?”
↵† Two “don't know” or blank responses.
↵‡ One “N/A” response.
↵§ One “don't know” or blank response.
↵¶ Three “don't know” or blank responses.
↵‖ Four “don't know” or blank responses.
