Article Figures & Data
Tables
- Table 1.
Factors (Conditions), Condition Descriptors, and Qualitative Comparative Analysis Scoring (Calibration) Used to Identify Key Ingredients in Successful Registry Implementation
Condition Description of Condition Calibration Health system The degree to which the practice was part of a large, multi-practice, hospital-owned health system 1 = practice is owned by health system, complete control 0 = practice is owned by the physicians or others in the practice Key person The degree to which there was a key person who “made things happen” for the registry implementation 1 = very clear evidence of a key person; there, willing, and capable to do what was needed 0 = no evidence of a key person or key persons; no one willing to step in and make things happen QI mindset The degree to which the practice displayed a mindset of interest in continually improving quality, looking for opportunity to change and get better 1 = Past and ongoing QI mindset evident in multiple practice members; institutionalized or embedded in practice culture 0 = No evidence of QI mindset, often evidence of contrary attitude (resisting change) EHR capability The extent to which the EHR had the capability to be changed to accommodate development of a registry; includes the extent to which the practice members or others in the system had the skills and knowledge to make these changes 1 = EHR with registry features already included or completely able to make any changes needed; including consideration of the system capability and the organization allowing these changes 0 = EHR not modifiable; cannot manipulate at all to meet reporting needs Resources The tangible items such as funding (to support people or EHR modifications), space, and time to complete necessary actions to get the registry to work 1 = sufficient resources to “get the job done,” for example, training or dedicated time provided for on the ground key person to implement or maintain registry 0 = lacking in resources such that a barrier or barriers were created, for example, no training provided when needed, or no time dedicated in already full workload for added tasks Leadership Usually at the health system level, but also at the practice level (if independent practice) to initiate and support changes for registry implementation 1 = significant organizational leadership role in driving and supporting the change 0 = no organizational leadership role in driving or supporting the change Incentives Anticipation of or actual availability of incentives for transformation, such as reimbursement changes or accreditation, as a motivator for PCMH transformation. 1 = actual or potential for significant financial incentives as a driver of transformation 0 = no incentives (in place or anticipated) as driver of transformation OUTCOME: registry implementation “success” Extent to which the practice was able to implement a fully functioning registry within their EHR within the time frame of the QI project 1 = Completed full registry and had ability to report data as needed 0 = Completely unable to implement registry or report needed data Interview (No.) Interview (%) Practice specialty Family medicine 10 77 Internal medicine 1 8 College health/ 2 15 Gynecology Practice ownership Part of group (network, hospital system, independent practice association) 9 69 Not part of group 4 31 Number interviewed at the practice 1 practice representative 9 69 2–4 practice representatives 3 31 Range (min-max) Mean, median Practice size Number of physicians (MD or DO) 1 to 10 3.7, 4.0 Practice Numbers (or Observation) Health System Key Person QI Mindset EHR Capability Resources Leadership Incentives Outcome: Registry Success P1 0.6 1.00 0.90 0.90 0.75 0.65 0.35 1.00 P2 0.8 0.70 0.75 0.30 0.90 0.90 0.80 0.65 P3 1 0.60 0.35 0.65 0.80 0.65 0.28 0.70 P4 1 0.10 0.85 0.90 0.75 0.90 0.30 0.90 P5 1 0.85 0.85 0.90 0.70 0.75 0.70 0.90 P6 1 0.85 0.80 0.90 0.80 0.80 0.40 0.90 P7 1 0.25 0.80 0.85 0.65 0.70 0.65 0.80 P8 0.6 0.85 0.90 0.90 0.85 0.85 0.20 0.95 P9 0.8 0.95 1.00 0.70 1.00 0.95 0.90 0.80 P10 0 1.00 0.85 0.75 0.80 0.80 0.80 0.85 P11 0.8 0.70 0.85 0.10 0.00 0.90 0.80 0.20 P12 0 0.95 0.85 0.75 0.75 0.75 0.75 0.70 P13 0 0.80 0.90 0.70 0.75 0.80 0.00 0.75 Data are originally qualitative in nature and through a group consensus process, researchers assign a score from 0 to 1.0 to calibrate the results for each cell to indicate the extent to which this condition is present for each practice with 1 = condition fully present and 0 = condition fully not present. This table summarizes the calibrated scores for all the conditions and outcome for each practice.
Configurations Leading to Successful Registry Implementation Consistency Raw Coverage Unique Coverage Observations with Strong Membership in this Configuration HEALTHSYSTEM*KEYPERSON* RESOURCE*LEADERSHIP 0.99 0.50 0.02 P:1,2,3,5,6,8,9 HEALTHSYSTEM*QIMINDSET* RESOURCES*LEADERSHIP 0.98 0.58 0.10 P:1,2,4,5,6,7,8,9 KEYPERSON*QIMINDSET* RESOURCES*LEADERSHIP 0.97 0.73 0.25 P:1,2,5,6,8,9,10,12,13 Solution 0.97 0.86 NA NA This sufficiency analysis identifies three overlapping combinations of conditions that produced successful registry implementations. These solutions indicate that sufficient resources and strong leadership always accompanied successful registry implementations. Within large health care systems, success resulted when these conditions were combined with either a keyperson or a strong QI mindset. Alternatively, the combination of sufficient resources and strong leadership with both a key person and a strong QI mindset was sufficient for a successful outcome, regardless of the size of the healthcare system. The high consistency and coverage scores reported in the final row indicate that practices exhibiting one of these three combinations of conditions were almost always successful in implementing a healthcare registry and, furthermore, that almost all instances of successful registry implementation exhibited one of these three combinations of conditions.
Configurations Leading to Successful Registry Implementation Consistency Raw Coverage Unique Coverage Observations with Strong Membership in this Configuration KEYPERSON*RESOURCES*LEADERSHIP+ 0.97 0.76 0.25 P1; P2; P3; P5; P6; P8; P9; P10; P12; P13 HEALTHSYSTEM*RESOURCES*LEADERSHIP 0.98 0.61 0.11 P1; P2; P3; P4; P5; P6; P7; P8; P9 Solution 0.96 0.87 NA Recognizing and classifying QI mindset as a necessary condition produces a simpler set of sufficiency results. Here, there are two overlapping pathways to successful registry implementation. The pathways both include sufficient resources and strong leadership in combination with either a large hospital-owned heath care system or a key person. The high consistency and coverage scores for the full model indicate that practices exhibiting either of these combinations of conditions were almost always successful in implementing a healthcare registry and that almost all instances of successful registry implementation exhibited one of these combinations.
