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Research ArticleOriginal Research

Tailoring Implementation Strategies for Cardiovascular Disease Risk Calculator Adoption in Primary Care Clinics

Laura-Mae Baldwin, Leah Tuzzio, Allison M. Cole, Erika Holden, Jennifer A. Powell and Michael L. Parchman
The Journal of the American Board of Family Medicine December 2022, 35 (6) 1143-1155; DOI: https://doi.org/10.3122/jabfm.2022.210449R1
Laura-Mae Baldwin
From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP).
MD, MPH
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Leah Tuzzio
From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP).
MPH
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Allison M. Cole
From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP).
MD, MPH
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Erika Holden
From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP).
BA
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Jennifer A. Powell
From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP).
MPH, MBA
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Michael L. Parchman
From Department of Family Medicine, University of Washington, Seattle, WA (L-MB, AMC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (LT, EH, MLP); Powell and Associates, LLC, Asheville NC (JAP).
MD, MPH
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Abstract

Introduction: When implementing interventions in primary care, tailoring implementation strategies to practice barriers can be effective, but additional work is needed to understand how to best select these strategies. This study sought to identify clinicians’ contributions to the process of tailoring implementation strategies to barriers in clinical settings.

Methods: We conducted a modified nominal group exercise involving 8 implementation scientists and 26 primary care clinicians in the WWAMI region Practice and Research Network. Each group identified implementation strategies it felt would best address barriers to using a cardiovascular disease (CVD) risk calculator previously identified across 44 primary care clinics from the Healthy Hearts Northwest pragmatic trial (2015 to 2018). These barriers had been mapped beforehand to the Consolidated Framework for Implementation Research (CFIR) domains. We examined similarities and differences in the strategies that 30% or more of each group identified (agreed-on strategies) for each barrier and for barriers in each CFIR domain. We used the results to demonstrate how strategies might be tailored to individual clinics.

Results: Clinicians selected 23 implementation strategies to address 1 or more of the 13 barriers; implementation scientists selected 35. The 2 groups agreed on at least 1 strategy for barriers in each CFIR domain: Inner Setting, Outer Setting, Intervention Characteristics, Characteristics of Individuals, and Process. Conducting local needs assessment and assessing for readiness/identifying barriers and facilitators were the 2 most common implementation strategies chosen only by clinicians.

Conclusions: Clinician stakeholders identified implementation strategies that augmented those chosen by implementation scientists, suggesting that codesign of implementation processes between implementation scientists and clinicians may strengthen the process of tailoring strategies to overcome implementation barriers.

  • Cardiology
  • Cardiovascular Diseases
  • Decision Support Tools
  • Implementation Science
  • Needs Assessment
  • Primary Health Care
  • Quality Improvement
  • Stakeholder Participation
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The Journal of the American Board of Family Medicine: 35 (6)
The Journal of the American Board of Family Medicine
Vol. 35, Issue 6
November/December 2022
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Tailoring Implementation Strategies for Cardiovascular Disease Risk Calculator Adoption in Primary Care Clinics
Laura-Mae Baldwin, Leah Tuzzio, Allison M. Cole, Erika Holden, Jennifer A. Powell, Michael L. Parchman
The Journal of the American Board of Family Medicine Dec 2022, 35 (6) 1143-1155; DOI: 10.3122/jabfm.2022.210449R1

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Tailoring Implementation Strategies for Cardiovascular Disease Risk Calculator Adoption in Primary Care Clinics
Laura-Mae Baldwin, Leah Tuzzio, Allison M. Cole, Erika Holden, Jennifer A. Powell, Michael L. Parchman
The Journal of the American Board of Family Medicine Dec 2022, 35 (6) 1143-1155; DOI: 10.3122/jabfm.2022.210449R1
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Keywords

  • Cardiology
  • Cardiovascular Diseases
  • Decision Support Tools
  • Implementation Science
  • Needs Assessment
  • Primary Health Care
  • Quality Improvement
  • Stakeholder Participation

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