Background
Methods
Setting
Sample
Data sources
Data analysis
Results
ERIC name | Current ERIC definition | Proposed changes to definition | Rationale for proposed change |
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Use data experts | Involve, hire, and/or consult experts to inform management on the use of data generated by implementation efforts | Involve, hire, and/or consult experts to acquire, structure, manage, report, and use data generated by implementation efforts | We broadened functions of data experts beyond just management of data. |
Fund and contract and/or negotiate with vendors for the clinical innovation | Governments and other payers of services issue requests for proposals to deliver the innovation, use contracting processes to motivate providers to deliver the clinical innovation, and develop new funding formulas that make it more likely that providers will deliver the innovation | None | We broadened the name to include the role of negotiation. Having outside assistance to negotiate with EHR vendors can be valuable in addition to payment. |
Provide local technical assistance | Develop and use a system to deliver technical assistance focused on implementation issues using local personnel | Develop and use a system to deliver technical assistance within local settings that is focused on implementation issues | We clarified the definition to indicate any technical assistance provided in the local setting, whether provided by local staff or by other on-site individuals. |
Audit and provide feedback | Collect and summarize clinical performance data over a specified time period and give it to clinicians and administrators to monitor, evaluate, and modify provider behavior | Develop summaries of clinical performance over a specific time period, often including a comparator, and give it to clinicians and/or administrators. Summary content (e.g., nature of the data, choice of comparator) and their delivery (e.g., mode, format) are designed to modify specifically targeted behavior(s) or actions of individual practitioners, teams, or health care organizations | We broadened the definition to include providing comparator data (benchmark) and to indicate that goal is to modify a targeted behavior and/or action of multiple actors. These facets are listed in ancillary materials but were not included in the published definition. |
Use an implementation advisor | Seek guidance from experts in implementation | Seek guidance from experts in implementation, including providing support and training for the implementation work force | We broadened this definition to include providing support and training for facilitators. |
Implementation facilitation | A process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship | [A] multi-faceted interactive process of problem solving, enabling and supporting individuals, groups and organizations in their efforts to adopt and incorporate innovations into routine practices that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship | The name was changed to specify “implementation” because facilitation is a very broad concept. Implementation facilitation includes practice facilitation, a more specific type of implementation facilitation. We broadened the definition to acknowledge that facilitation is more than just “interactive problem-solving.” |
Assess for readiness and identify barriers and facilitators | Assess various aspects of an organization to determine its degree of readiness to implement, barriers that may impede implementation, and strengths that can be used in the implementation effort | Assess various aspects of an organization to determine its degree of readiness to implement and identify barriers that may impede implementation and strengths that can be leveraged to facilitate the implementation effort | We revised to clarify identification of barriers and leveraging facilitators. |
Develop an implementation blueprint | Develop a formal implementation blueprint that includes all goals and strategies. The blueprint should include the following: (1) aim/purpose of the implementation; (2) scope of the change (e.g., what organizational units are affected); (3) timeframe and milestones; and (4) appropriate performance/progress measures. Use and update this plan to guide the implementation effort over time | Develop a formal implementation blueprint that includes all goals and strategies. The blueprint should include the following: (1) aim/purpose of the implementation; (2) scope of the change (e.g., what organizational units are affected); (3) timeframe and milestones; and (4) appropriate performance/progress measures. Use and update this plan to guide the implementation effort over time | We suggest deleting the word “Formal” to include informal as well as formal implementation blueprints. This will include plans that are developed for quality improvement as well as larger formal plans for implementation. Additionally, the definition is expanded to explicitly acknowledge its role in guiding implementation over time. |
Organize implementation teams and team meetings | Develop and support teams of clinicians who are implementing the innovation and give them protected time to reflect on the implementation effort, share lessons learned, and support one another’s learning | Develop and support teams of clinicians, staff, patients and other stakeholders who are implementing or may be users of the innovation. Provide protected time for teams to reflect on the implementation progress, share lessons learned, make refinements to plans, and support one another’s learning | We broadened the name to include all possible team members and to include formation of teams as well as meetings. Removing the term clinician allows for a multi-disciplinary team and increases engagement among all team members. We broadened definition to be inclusive of all team members and clarified intent of the definition. |
Develop educational materials | Develop and format manuals, toolkits, and other supporting materials in ways that make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation | Develop and format manuals, toolkits, and other supporting materials to make it easier for stakeholders to learn about the innovation and for clinicians to learn how to deliver the clinical innovation. This can include technology-delivered (e.g., online/smartphone-based static or dynamic) content and health messaging | We expanded to include technology-delivered content and messaging. |
Conduct educational outreach visits | Have a trained person meet with providers in their practice settings to educate providers about the clinical innovation with the intent of changing the provider’s practice | Have a trained person meet with individuals or teams in their work settings to educate them about the clinical innovation with the intent of changing behavior to reliably use the clinical innovation as designed | We broadened definition to include team members beyond providers and clarified language to more clearly state that this strategy aims to encourage sustained use of the innovation. |
Conduct ongoing training | Plan for and conduct training in the clinical innovation in an ongoing way | Plan for and conduct training in the clinical innovation in an ongoing way for all individuals involved with implementation and users of the clinical innovation e.g., clinicians, implementation staff, practice facilitators | We expanded the definition to include all individuals involved. |
Conduct educational meetings | Hold meetings targeted toward different stakeholder groups (e.g., providers, administrators, other organizational stakeholders, and community, patient/consumer, and family stakeholders) to teach them about the clinical innovation | Hold meetings targeted toward educating multiple stakeholder groups (i.e., providers, administrators, other organizational stakeholders, community members, patients/consumers, families) about the clinical innovation and/or its implementation | We revised the definition to add specificity about the purpose of the education (the innovation and/or its implementation) and to clarify that education is among multiple types of stakeholders. |
Assess and redesign workflow
| Observe and map current work processes and plan for desired work processes, identifying changes necessary to accommodate, encourage, or incentivize use of the clinical innovation as designed | New: Added as this work is not reflected in current ERIC strategies. | |
Create online learning communities
| Create an online portal for clinical staff members to share and access resources, webinars, and FAQs related to the specific evidenced-based intervention, and provide interactive features to encourage learning across settings and teams, e.g., regular blogs, facilitated discussion boards, access to experts, and networking opportunities | New: Added as this work is not reflected in current ERIC strategies. | |
Engage community resources
| Connect practices and their patients to community resources outside the practice (e.g., state and county health departments; non-profit organizations; resources related to addressing the social determinants of health; and organizations focused on self-management techniques and support | New: Added as this work is not reflected in current ERIC strategies. |
Expected outcomes: Ability to generate ABCS reports sufficient HIT capacity, ability to generate ABCS reports, ABCS documentation, data interoperability and sharing. Sustained performance quality measurement and use of data for QI Justification: Practices need population-level data and interoperability to improve quality and optimize care delivery, but they have little or no HIT capacity for this. Practices may need additional, external data infrastructure to provide robust practice-level, clinician-level, and patient-level data on demand. Practices often need internal support to access, validate, and use data for QI. Practices are motivated to improve upon seeing their own data | |||||
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No. co-ops | Name it | Specify it | |||
ERIC cluster | ERIC strategy* | Actor | Specific action(s) | Target | |
5 | Adapt and tailor to context | Use data experts | Cooperative leadership, data experts | Hire health informatics technology experts (called “data experts” in this table) to connect practices to external data infrastructures or hire practice facilitators skilled in health informatics technology (called HIT-PFs) to assist practices in generating and understanding EHR data | Cooperative, practice |
5 | Adapt and tailor to context | Use data warehousing techniques | Data expert, HIT-PF | Connect practice EHR to warehouse, repository, and/or other external durable infrastructures (i.e., registries and software platforms) | Practice |
6 | Use evaluative and iterative strategies | Develop and implement tools for quality monitoring | Data expert, HIT-PF | Perform the data extraction, data normalization, and “back-end” data validation necessary for data warehousing and other data platforms | Practice, data infrastructure |
6 | Use evaluative and iterative strategies | Develop and organize quality monitoring systems | Data expert, HIT-PF, PF | Connect practices to additional data interfaces for receiving ABCS data and other types of metrics (i.e., access to data software platforms like popHealth or Sharepoint or cooperative dashboards) | Practice |
3 | Utilize financial strategies | Fund and contract (and/or negotiate) with vendors for the clinical innovation | Cooperative leadership | Reimburse for registry connections for the duration of EvidenceNOW; negotiate with EHR vendors to connect practices to data infrastructure | Practice |
2 | Change infrastructure | Change records systems | Data expert | Help practices upgrade to new EHR and/or modify existing EHRs for efficiency and accuracy | Practice |
6 | Provide interactive assistance | Provide local technical assistance | Data expert, HIT-PF, PF | Audit charts to validate data reports; assist with helping practices improve ABCS documentation; help practices run/generate/pull reports; troubleshoot dashboards; help practice staff transition to and learn to use new EHR, if needed | Practice, PF |
7 | Use evaluative and iterative strategies | Audit and provide feedback | Data expert, HIT-PF, PF | Share ABCS data for feedback and monitor improvement over time. Most used ABCS data for audit and provide feedback, and several provided benchmarking to similar practices; a few included survey items and other sources of data for feedback | Practice |
Expected outcomes: Improve ABCS outcomes and QI capacity Improved ABCS measures and increased practice capacity to take on new quality initiatives. Additional outcomes may vary by cooperative (e.g., joy in practice). Knowledge of evidence-based guidelines and QI techniques and principles is needed Justification: practices are under-resourced for quality improvement and need external support to guide them through the change process. Implementation staff needs a supportive infrastructure to help them help practices achieve their goals | |||||
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No. co-ops | Name it | Specify it | |||
ERIC cluster | ERIC strategy* | Actor | Specific action(s) | Target | |
7 | Provide interactive assistance | Implementation facilitation | PF | Assist with the change process and support change efforts; review workflows and create actionable plans to put best practices in place (i.e., huddles, pre-visit planning, medication synchronization, gaps analysis, outreach, decision support use, patient education, etc.) | Practice |
7 | Use evaluative and iterative strategies | Assess for readiness and identify barriers and facilitators | Data expert HIT-PF, PF | Assess HIT needs and data set-up and workflow; assess clinic workflows; assess use of evidence-based protocols | Practice |
7 | Use evaluative and iterative strategies | Develop an implementation blueprint | PF, HIT-PF | Discuss and identify improvement plan; adjust plans according to data; develop actionable plans for implementation of evidence-based protocols and addressing other pain points (i.e. non-compliant patients) | Practice |
6 | Use evaluative and iterative strategies | Conduct cyclical small tests of change | PF | Develop and use Plan Do Study Act (PDSA), Define Measure Analyze Improve and Control (DMIAC), and other tests of change activities and processes involved in QI | Practice |
5 | New |
Assess and redesign workflow
| PF | Assess and revise clinic workflows using a variety of techniques (i.e., observations and mapping of workflow, role-redesign exercises) to facilitate discussion and implementation of evidence-based protocols | Practice |
4 | Support clinicians | Remind clinicians | PF | Assist the change process through use of clinical reminders and decision-support tools | Practice |
4 | Develop stakeholder interrelationships | Identify and prepare champions | PF | Assist in creating and engaging practice leaders and others in promoting efficient care strategies | Practice |
4 | Develop stakeholder interrelationships | Recruit, designate and train for leadership | PF | Assist in creating and facilitating practice leaders and others in promoting efficient care strategies | Practice |
4 | Develop stakeholder interrelationships | Organize implementation teams and team meetings | PF | Assist in creating and facilitating QI teams in promoting efficient care strategies | Practice |
4 | Engage consumers | Intervene with patients/consumers to enhance uptake and adherence | PF | Help generate patient lists for outreach from EHRs or registries; recall patients; offer patient education materials | Practice |
5 | Develop stakeholder interrelations | Use an implementation advisor | Expert consultant PF-HIT | Support and education for practice facilitators by data experts and/or physician faculty hired as expert consultants | PF |
Expected outcomes: Clinician knowledge of ABCS & QI and exchange best practices Knowledge of clinical guidelines, use of local resources, and increased peer interaction encouraging continued engagement and participation in QI. Exchange of best practices, peer learning and support Justification: Clinicians benefit from learning in a variety of formats (peer-to-peer; online learning; in-person one-on-one or group learning) from different professionals (expert consultants who are also clinical peers, practice facilitators, other healthcare experts). Interactive, collaborative learning and peer networking help practices engage in QI and reduce burnout | |||||
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No. co-ops | Name it | Specify it | |||
ERIC cluster | ERIC strategy* | Actor | Specific action(s) | Target | |
7 | Train and educate stakeholders | Develop educational materials | Cooperative leadership, expert consultants, PF | Develop webinars, Q & A, toolkit, training modules, and online resources; compile lists of community resources | Practice |
7 | Train and educate stakeholders | Distribute educational materials | Expert consultant, community health improvement organization, extension agent, PF | Host didactic webinars and videos and post toolkits, modules, Q & A/FAQ online for asynchronous learning; provide information during in person visits, such as listing of community resources; support change efforts through providing educational materials and working on them with practices; establish links to community resources | Practice |
1 | Train and educate stakeholders | Conduct educational outreach visits | Expert consultants, data experts | Hold one-on-one meetings with practice to educate on clinical topics; visits to train practice data champion in data reporting/data use training | Practice |
3 | Train and educate stakeholders | Provide ongoing consultation | Expert consultants | Provide expert advice by email or in person | Practice |
3 | Train and educate stakeholders | Conduct ongoing training | Expert consultants | Provide interactive training webinars and “office hours” on clinical topics related to the ABCS; include time for Q & A. Provide training on cardiovascular disease risk calculators and other clinical tools | Practice |
3 | Train and educate stakeholders | Create a learning collaborative | Cooperative leadership, PF, practice | Hold events for practices to learn from and interact with cooperative staff about the clinical interventions as well as interact with other practices, workshop practice needs, and create plans for embarking on or continuing with intervention change processes | Practice |
2 | New |
Create online learning communities
| Cooperative leadership, PF, practice | Create online forum with access to resources, networking, and discussions | Clinical community |
5 | Train and educate stakeholders | Conduct educational meetings | Cooperative leadership, expert consultants, PF, practice | Hold collective meetings for practices with cooperatives for the purpose of orienting the practice to the intervention and educating practice members on clinical topics and/or best practices; practice facilitators may hold collaborative calls or meetings with practices for training on particular topics of practices’ choice | Practice |
1 | Train and educate stakeholders | Shadow other experts | Cooperative leadership, practice | Select exemplar practices for other practices to visit; visits may be in person or virtual | Practice |
2 | Develop stakeholder interrelations | Visit other sites | Cooperative leadership, practice | Select exemplar practices for other practices to visit or bring together local practices to discuss best practices and intervention successes and challenges; visits may be in person or virtual | Practice |
4 | Develop stakeholder interrelations | Promote network weaving | Cooperative leadership, PF, practice | Encourage networking between practices to build a clinical community for best practices | Practice |
5 | Develop stakeholder interrelation-ships | Capture and share local knowledge | Cooperative leadership, expert consultants, PF, practice | Hold in-person meetings or events or phone calls so that practices can learn from each other and engage in discussion; visit exemplar practices; facilitate networks and learning events in the region; host a small group of practices in one clinic; use online portal for virtual learning | Practice |
Expected outcomes: Improved community connections and patient involvement Improved referrals to accessible patient resources, improved patient engagement in their own care. Increased patient activation and knowledge leads to acceptance of new evidence-based practices and increased quality of care Justification: Local resources help practices and patients improve cardiovascular preventive care and self-management. Patient feedback and involvement in QI promotes patient-clinician communication, tailored health messaging, and patient adherence | |||||
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No. co-ops | Name it | Specify it | |||
ERIC cluster | ERIC strategy* | Actor | Specific action(s) | Target | |
5 | New |
Engage community resources
| PF, extension agent | Build links between practices and health resources or organizations embedded in communities; varies from meetings with community organizations and participating in collaborative project to participating in referral programs | Practice |
1 | Support clinicians | Develop resource sharing agreements | Cooperative leadership | Connect to state and county departments of health; connect practices to local health related organizations to participate in collaborative projects | Practice |
1 | Engage consumers | Involve patients/consumers and family members | Cooperative leadership, PF | Include patients on QI teams | Practice |
2 | Use evaluative and iterative strategies | Obtain and use patients/consumers and family feedback | Cooperative leadership, PF | Assess and use results of patient/consumers and family feedback from patient engagement surveys; patient focus group, patient and family advisory councils | Practice |
1 | Engage consumers | Prepare patients/consumers to be active participants | PF | Invite members of the community to participate in tailoring ABCS and CVD messaging for their communities | Practice |