Dissemination and Implementation
Partnering With Quality Improvement and Population Health Initiatives
|Douglas Zatzick, MD
|Beverly Green, MD, MPH|
Karen Staman, MS
When developing and implementing a pragmatic study, it is may be useful to partner with quality improvement and population health personnel at sites; if the results of the PCT are positive, they may align with organizational goals for improving care. Tools and technologies can be developed so they are easily adaptable for use in various departments with different electronic health record systems.
Case Example: ICD-Pieces
- The goal of the Improving Chronic Disease Management with Pieces (ICD-Pieces) trial is to improve care for patients with chronic kidney disease, diabetes, and hypertension by using a novel technology platform (Pieces) that uses the electronic health record to identify patients and by assigning practice facilitators within primary care practices or community medical homes.
The investigators of ICD-Pieces used a novel information technology (Pieces) to identify patients with chronic kidney disease, diabetes, and hypertension through the electronic health record and assign practice facilitators to these patients to improve their care. Pieces can be integrated into various electronic health record systems—Epic, CPRS, All Scripts, or customized spreadsheets. The IT algorithms in ICD-Pieces were designed to be relatively simple for the IT team to implement should the healthcare system decide to allocate resources for this purpose, as improving the care of patients with multiple co-morbidities aligns with quality improvement and population health goals.
If the results are positive, participating healthcare systems would implement the results in different manners, but it is likely that quality improvement or population medicine groups would drive the uptake.
|Diffusion||Once results are available there will be initial presentations to administrators and clinical leaders. Next steps will include presentations to other groups in the healthcare system and publication of trial results|
|Dissemination||Investigators will have information about how many hospitalizations, readmissions, emergency room visits, cardiovascular events and deaths could be potentially saved through the intervention. This could be translated into better outcomes and even cost savings. Healthcare systems will be interested in this information. Visits to clinics, education sessions and webinars will be held in the participating sites.|
|Implementation||If trial demonstrates value, quality improvement and population health departments will allocate IT resources and practice facilitators across healthcare systems. Patient lists, practice alerts and order sets will be available for use across the healthcare systems.|
|Sustainability||If quality of care measures improve after implementing the intervention—and the detection of patients translates into better care, then it is expected that quality improvement and population medicine departments will continue to coordinate allocation of IT resources and practice facilitators and monitor performance to drive long-term sustainability.|
- Conceptualizing the Challenge
- Dissemination and Implementation Frameworks
- Let It, Help It, Make It Happen
- Changes to Policy and Guidelines
- Legislative Changes
- Creation of Targeted Tools
- Stepped Wedge Designs
- Intervention Staffing and Training Flexibility
- Partnering With Quality Improvement and Population Health Initiatives
- Implementation in the Trial Versus in the Real World
- Additional Resources