1. Preliminary Themes Related to the Stakeholder Engagement for Automated Data Acquisition for Heart Failure
Megha Kalsy, MS1, Natalie Kelly, MBA3, Jennifer H. Garvin, PhD, MBA, RHIA1,2,3
1Department of Biomedical Informatics, University of Utah, Salt Lake City, UT; 2Division of Epidemiology, 3VA Health Care System, Salt Lake City, UT
Research Question
What is the context of Implementation at the national, VISN, and local level in terms of the internal organizational features?
Abstract
We undertook a stakeholder engagement process as part of a Department of Veteran Affairs (VA) study. We developed an automated data acquisition process for inpatient congestive heart failure quality measurement. We used thematic analysis to understand the context of implementation using a combination of the PARIHS framework1 of Implementation Science and the Socio-Technical Model of Health Information Technology2. We identified 5 preliminary themes associated with internal organizational features.
PARIHS FRAMEWORK
Hardware and software
Measuring and
monitoring
Clinical content
Methods
We used a snowball sampling technique to identify interviewees.
We developed questions and an interview guide and undertook interviews. The approach was “Applied” – to solve a problem using a theoretical thematic analysis6.
Two independent reviewers each created summaries and we summarized the main points in the interview and sent them to interviewees for validation. We used the validated summaries to generate preliminary themes (codes) to answer our research question.
Research groups met to develop consensus codes on master themes. Three documents resulted – two summaries, group-consensus codes, consensus codes with highlighted text.
EVIDENCE
CONTEXT
SOCIO-TECHNICAL
MODEL
of HIT
Internal Organizational
Features
Human-computer
interface
Introduction
The goal of our stakeholder engagement process was to understand the context of a potential implementation of an automated quality measurement system for inpatients with congestive heart failure.
We used the PARIHS framework1, which includes the elements of evidence, context, and facilitation, as well as the Socio-Technical Model of Health Information Technology to guide our approach.
Prior studies have shown that Health Information Technology (HIT) can be used as a facilitator within the PARIHS framework3.
We used the Socio-Technical Model2 and focused on four dimensions: hardware and software, clinical content, workflow and communication, and internal organizational features.
Previous research found that internal organizational factors relate to sustained quality4 and therefore assessed themes related to this dimension of the Socio-Technical Model.
We used qualitative techniques to undertake5 stakeholder engagement and analyze6 resulting data.
People
FACILITATION
External Rules
Workflow and
Communication
Results/Discussion
We interviewed 10 stakeholders. The interviewees included, among other job categories: clinical quality specialists; directors of quality management, clinical analysis and reporting; epidemiology; clinicians and pharmacists; and program analysts.
The range for the number of years working in the VA of interviewees was years with 3 interviewees unknown. And similarly, the range for the number of years working in quality/patient safety is 6-33 years with 3 unknown.
The preliminary themes associated with internal organizational features were use of: evidence based care, quality improvement, measurement and accountability processes, performance measurement mechanisms, and quality control reporting.
IN COMBINATION WITH
To answer the research question:
What is the context of Implementation at the
national, VISN, and local level in terms of the
internal organizational features?
References
Rycroft-Malone, J. (2004). The PARIHS framework--a framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality, 19(4), 297–304.
Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl 3), i68–i74. doi: /qshc
Goldstein, M. K. (2008). Using health information technology to improve hypertension management. Current Hypertension Reports, 10(3), 201–207.
Lukas, C. V., Holmes, S. K., Cohen, A. B., Restuccia, J., Cramer, I. E., Shwartz, M., & Charns, M. P. (2007). Transformational change in health care systems: an organizational model. Health Care Management Review, 32(4), 309–320. doi: /01.HMR d
Flick, U. (2007). The SAGE Qualitative Research Kit London: Sage Publications.
Guest, G. (2012). Applied thematic analysis. Thousand Oaks, California: Sage.
Results
The preliminary themes associated with internal organizational features were use of:
evidence based care
quality improvement
measurement and accountability processes
performance measurement mechanisms
quality control reporting
Contact Information:
Acknowledgements
Research supported by VA HSR&D IBE Views expressed are those of authors and not necessarily those of the Department of Veterans Affairs or affiliated institutions.
Conclusions
Stakeholder engagement process is essential to identify barriers and facilitators to HIT implementation.
Using the PARIHS Framework and the Socio-technical Model of HIT can help in designing our HIT to facilitate the use of evidence-based medicine.