Implementation science for ambulatory care safety: a novel method to develop context-sensitive interventions to reduce quality gaps in monitoring high-risk patients.
Background: Missed evidence-based monitoring in high-risk conditions (e.g., cancer) leads to delayed diagnosis. Current technological solutions fail to close this safety gap. In response, we aim to demonstrate a novel method to identify common vulnerabilities across clinics and generate attributes f...
| Publicado en: | Implementation Science Vol. 12; no. 1; pp. 1 - 18 |
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| Autores principales: | , , , , , |
| Formato: | research Journal Article |
| Publicado: |
BioMed Central
6/24/2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123797244&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 123797244 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 17485908 38MN jtl: Implementation Science issn: 17485908 maglogo: N pubinfo: dt: 6/24/2017 vid: 12 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 123797244 123797244 NLM28646886 123797244 10.1186/s13012-017-0609-5 NLM28646886 123797244 ppf: 1 ppct: 17 formats: tig: atl: Implementation science for ambulatory care safety: a novel method to develop context-sensitive interventions to reduce quality gaps in monitoring high-risk patients. aug: au: McDonald, Kathryn M. Su, George Lisker3, Sarah Patterson, Emily S. Sarkar, Urmimala Lisker, Sarah affil: University of California Berkeley, School of Public Health, 50 University Hall, Berkeley 94720, CA, U.S.A. sug: subj: Ambulatory Care Methods Health and Welfare Planning Methods Quality of Health Care Neoplasms Diagnosis Patient Safety Standards Diagnosis, Delayed Medical Practice, Evidence-Based Methods Reproducibility of Results California Ambulatory Care Standards Validation Studies Comparative Studies Evaluation Research Multicenter Studies Human Funding Source ab: Background: Missed evidence-based monitoring in high-risk conditions (e.g., cancer) leads to delayed diagnosis. Current technological solutions fail to close this safety gap. In response, we aim to demonstrate a novel method to identify common vulnerabilities across clinics and generate attributes for context-flexible population-level monitoring solutions for widespread implementation to improve quality.Methods: Based on interviews with staff in otolaryngology, pulmonary, urology, breast, and gastroenterology clinics at a large urban publicly funded health system, we applied journey mapping to co-develop a visual representation of how patients are monitored for high-risk conditions. Using a National Academies framework and context-sensitivity theory, we identified common systems vulnerabilities and developed preliminary concepts for improving the robustness for monitoring patients with high-risk conditions ("design seeds" for potential solutions). Finally, we conducted a face validity and prioritization assessment of the design seeds with the original interviewees.Results: We identified five high-risk situations for potentially consequential diagnostic delays arising from suboptimal patient monitoring. All situations related to detection of cancer (head and neck, lung, prostate, breast, and colorectal). With clinic participants we created 5 journey maps, each representing specialty clinic workflow directed at evidence-based monitoring. System vulnerabilities common to the different clinics included challenges with: data systems, communications handoffs, population-level tracking, and patient activities. Clinic staff ranked 13 design seeds (e.g., keep patient list up to date, use triggered notifications) addressing these vulnerabilities. Each design seed has unique evaluation criteria for the usefulness of potential solutions developed from the seed.Conclusions: We identified and ranked 13 design seeds that characterize situations that clinicians described 'wake them up at night', and thus could reduce their anxiety, save time, and improve monitoring of high-risk patients. We anticipate that the design seed approach promotes robust and context-sensitive solutions to safety and quality problems because it provides a human-centered link between the experienced problem and various solutions that can be tested for viability. The study also demonstrates a novel integration of industrial and human factors methods (journey mapping, process tracing and design seeds) linked to implementation theory for use in designing interventions that anticipate and reduce implementation challenges. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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