Accelerating the Use of Findings from Patient-Centered Outcomes Research in Clinical Practice to Improve Health and Health Care Proceedings of a Workshop Series (2022) / Chapter Skim
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10 Workshop 3, Session 2: Measuring the Impact of Dissemination Projects Part 2
10 Workshop 3, Session 2: Measuring the Impact of Dissemination Projects Part 2
Pages 81-94
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From page 81... ...
and the Normalization Process Theory model can serve as frameworks for developing effective dissemination and implementation programs for digital tools. (Politi)
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From page 82... ...
project, an initiative funded by the American Heart Association to test behavioral economics interventions. The study seeks to determine whether behavioral economics interventions are an effective mechanism to surmount the barriers to randomized controlled trial participation faced by people from disenfranchised racial and ethnic groups, women, people with low incomes, or people with a medical risk of cardiovascular disease.
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From page 83... ...
This measure will also enable researchers to determine the true FIGURE 10-2 A large difference in the slope of the enrollment versus incentive size according to economic status indicates that the incentive results in unjust inducement (graph is for illustrative purposes and does not represent data from an actual study) SOURCE: Presented by Alisa Stephens-Shields on July 1, 2022, at Accelerating the Use of Findings from Patient-Centered Outcomes Research in Clinical Practice to Improve Health and Health Care: A Workshop Series.
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From page 84... ...
Louis School of Medicine, discussed clinician engagement with decision support tools using a breast reconstruction digital support tool project she collaborated on as an example. The project involved a diverse group of stakeholders and researchers from Washington University in St.
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From page 85... ...
as a framework for understanding behavior change as they began considering their approach to facilitating clinician engagement with the decision support tool. They identified four required elements for clinicians to change their behavior (engage with the tool)
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Patients initially receive access to the web-based breast reconstruction decision tool, which describes the different options for breast reconstruction, via the patient portal for their physician's EHR or email. The tool includes educational modules that address whether to have breast reconstruction; types of reconstruction procedures; timing and risk for each type of procedure; and reconstruction outcome photos.
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From page 87... ...
Politi noted that further research is needed to ascertain optimal design for the tool, including how best to provide alerts. Other subjects for future research include determining how to integrate clinician components into patient-facing tools; investigating the role of EHR restrictions, institution policies, and culture in the effectiveness of the decision support tool; how to build on existing workflows and engage clinical champions; and investigating whether integrating engagement with decision support tools into resident training would increase clinician engagement.
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From page 88... ...
Chaiyachati and his colleagues designed a digital tool that could identify patients who were developing shortness of breath because that had been identified as a symptom associated with poor disease outcome. The result was a text message–based program called COVID Watch (Morgan et al., 2020)
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Chaiyachati noted that more than 30 individuals were involved in creating COVID Watch. This highlighted the complexity of designing a robust program that integrates with existing technology, engages the clinical team, and enables the research evaluation needed to generate supporting evidence.
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He suggested that there are opportunities to blend behavioral health economics with social science, implementation science, statistics, and other fields to accelerate the process of translating research discoveries into clinical practices. Behavioral economics principles can be tested with small changes during the preparation phase; such tests can be done quickly in a small trial, which can reduce delays during the later stages of determining a final design.
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From page 91... ...
Chaiyachati said metrics that are applied across patient populations and across delivery organizations would provide information about equity and the inequities that might occur with an intervention. This is not something that AHRQ has explicitly asked research communities to consider when an intervention targets a population that has traditionally had challenges accessing care.
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From page 92... ...
He suggested that funders should consider whether they could support health care systems to address these challenges. Scholle asked the group to discuss possible strategies to address alert fatigue that may interfere with the effectiveness of nudges or other tools designed to draw a clinician's attention.
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Speakers' Closing Thoughts To conclude the discussion, Scholle asked the panelists for any final thoughts regarding the most important things that would be beneficial for AHRQ to consider related to evaluating the effectiveness of its implementation and dissemination projects. Chaiyachati replied that from his perspective, there is a need to move beyond individual tests and the practice level and consider scalability and spread across multiple health systems.
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From page 94... ...
94 ACCELERATING THE USE OF FINDINGS FROM PCOR Hughes also described speaker suggestions for developing effective dissemination and implementation projects. These included3 • Developing strategies to address the need for infrastructure that will enable researchers and clinicians to access to the rapidly growing amount of health care; • Supporting dissemination of research results beyond presentations at academic conferences; • Leveraging behavioral economic insights to support dissemination and implementation efforts; • Considering the use of digital health tools and technologies to enhance health equity, personalize health care, and increase the efficiency of care; • Examining how rigid structures and workflows may impede progress; and • Learning from how other industries innovate.
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