|
1
|
Schlechter CR, Reese TJ, Wirth J, Gibson B, Kawamoto K, Siaperas T, Pruhs A, Dinkins CP, Zhang Y, Friedrichs M, George S, Lam CY, Pierce JH, Borsato EP, Cornia RC, Stevens L, Martinez A, Bradshaw RL, Kaphingst KA, Hess R, Del Fiol G, Wetter DW. Rapid-cycle designs to adapt interventions for COVID-19 in safety-net healthcare systems. Transl Behav Med 2023; 13:389-399. [PMID: 36999823 PMCID: PMC10255772 DOI: 10.1093/tbm/ibac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Racial/ethnic minority, low socioeconomic status, and rural populations are disproportionately affected by COVID-19. Developing and evaluating interventions to address COVID-19 testing and vaccination among these populations are crucial to improving health inequities. The purpose of this paper is to describe the application of a rapid-cycle design and adaptation process from an ongoing trial to address COVID-19 among safety-net healthcare system patients. The rapid-cycle design and adaptation process included: (a) assessing context and determining relevant models/frameworks; (b) determining core and modifiable components of interventions; and (c) conducting iterative adaptations using Plan-Do-Study-Act (PDSA) cycles. PDSA cycles included: Plan. Gather information from potential adopters/implementers (e.g., Community Health Center [CHC] staff/patients) and design initial interventions; Do. Implement interventions in single CHC or patient cohort; Study. Examine process, outcome, and context data (e.g., infection rates); and, Act. If necessary, refine interventions based on process and outcome data, then disseminate interventions to other CHCs and patient cohorts. Seven CHC systems with 26 clinics participated in the trial. Rapid-cycle, PDSA-based adaptations were made to adapt to evolving COVID-19-related needs. Near real-time data used for adaptation included data on infection hot spots, CHC capacity, stakeholder priorities, local/national policies, and testing/vaccine availability. Adaptations included those to study design, intervention content, and intervention cohorts. Decision-making included multiple stakeholders (e.g., State Department of Health, Primary Care Association, CHCs, patients, researchers). Rapid-cycle designs may improve the relevance and timeliness of interventions for CHCs and other settings that provide care to populations experiencing health inequities, and for rapidly evolving healthcare challenges such as COVID-19.
Collapse
Affiliation(s)
- Chelsey R Schlechter
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Wirth
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Tracey Siaperas
- Association for Utah Community Health, Salt Lake City, UT, USA
| | - Alan Pruhs
- Association for Utah Community Health, Salt Lake City, UT, USA
| | | | - Yue Zhang
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - Stephanie George
- Utah Department of Health and Human Services, Salt Lake City, UT, USA
| | - Cho Y Lam
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Joni H Pierce
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Emerson P Borsato
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Ryan C Cornia
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Leticia Stevens
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Anna Martinez
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
|
2
|
Kawamoto K, Kukhareva PV, Weir C, Flynn MC, Nanjo CJ, Martin DK, Warner PB, Shields DE, Rodriguez-Loya S, Bradshaw RL, Cornia RC, Reese TJ, Kramer HS, Taft T, Curran RL, Morgan KL, Borbolla D, Hightower M, Turnbull WJ, Strong MB, Chapman WW, Gregory T, Stipelman CH, Shakib JH, Hess R, Boltax JP, Habboushe JP, Sakaguchi F, Turner KM, Narus SP, Tarumi S, Takeuchi W, Ban H, Wetter DW, Lam C, Caverly TJ, Fagerlin A, Norlin C, Malone DC, Kaphingst KA, Kohlmann WK, Brooke BS, Del Fiol G. Establishing a multidisciplinary initiative for interoperable electronic health record innovations at an academic medical center. JAMIA Open 2021; 4:ooab041. [PMID: 34345802 PMCID: PMC8325485 DOI: 10.1093/jamiaopen/ooab041] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/18/2021] [Accepted: 05/04/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To establish an enterprise initiative for improving health and health care through interoperable electronic health record (EHR) innovations. Materials and Methods We developed a unifying mission and vision, established multidisciplinary governance, and formulated a strategic plan. Key elements of our strategy include establishing a world-class team; creating shared infrastructure to support individual innovations; developing and implementing innovations with high anticipated impact and a clear path to adoption; incorporating best practices such as the use of Fast Healthcare Interoperability Resources (FHIR) and related interoperability standards; and maximizing synergies across research and operations and with partner organizations. Results University of Utah Health launched the ReImagine EHR initiative in 2016. Supportive infrastructure developed by the initiative include various FHIR-related tooling and a systematic evaluation framework. More than 10 EHR-integrated digital innovations have been implemented to support preventive care, shared decision-making, chronic disease management, and acute clinical care. Initial evaluations of these innovations have demonstrated positive impact on user satisfaction, provider efficiency, and compliance with evidence-based guidelines. Return on investment has included improvements in care; over $35 million in external grant funding; commercial opportunities; and increased ability to adapt to a changing healthcare landscape. Discussion Key lessons learned include the value of investing in digital innovation initiatives leveraging FHIR; the importance of supportive infrastructure for accelerating innovation; and the critical role of user-centered design, implementation science, and evaluation. Conclusion EHR-integrated digital innovation initiatives can be key assets for enhancing the EHR user experience, improving patient care, and reducing provider burnout.
Collapse
Affiliation(s)
- Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Polina V Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Michael C Flynn
- University of Utah Health, Salt Lake City, Utah, USA.,Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Claude J Nanjo
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Douglas K Martin
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Phillip B Warner
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - David E Shields
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Salvador Rodriguez-Loya
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Richard L Bradshaw
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Ryan C Cornia
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA
| | - Thomas J Reese
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Heidi S Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Rebecca L Curran
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Keaton L Morgan
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Maia Hightower
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Michael B Strong
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Wendy W Chapman
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | | | - Carole H Stipelman
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Julie H Shakib
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Hess
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan P Boltax
- Division of Pulmonary Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Joseph P Habboushe
- MD Aware, LLC, New York, New York, USA.,Department of Emergency Medicine, New York University, New York, New York, USA
| | - Farrant Sakaguchi
- University of Utah Health, Salt Lake City, Utah, USA.,Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.,Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kyle M Turner
- University of Utah Health, Salt Lake City, Utah, USA.,Community Physicians Group, University of Utah, Salt Lake City, Utah, USA.,Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Scott P Narus
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,Intermountain Healthcare, Murray, Utah, USA
| | - Shinji Tarumi
- Research & Development Group, Hitachi, Ltd, Tokyo, Japan
| | | | - Hideyuki Ban
- Research & Development Group, Hitachi, Ltd, Tokyo, Japan
| | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Cho Lam
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Tanner J Caverly
- VA Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Departments of Learning Health Sciences and Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA.,VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, Utah, USA
| | - Chuck Norlin
- University of Utah Health, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Daniel C Malone
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Communication, University of Utah, Salt Lake City, Utah, USA
| | - Wendy K Kohlmann
- University of Utah Health, Salt Lake City, Utah, USA.,Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Benjamin S Brooke
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|