A Web-Based, Population-Based Cirrhosis Identification and Management System for Improving Cirrhosis Care: Qualitative Formative Evaluation.

Autor:	Javier SJ; Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, United States., Wu J; Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, United States., Smith DL; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, United States., Kanwal F; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, United States.; Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, United States.; Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States., Martin LA; National Institute of Environmental Health Sciences (NIEHS), Division of Extramural Research & Training, Population Health Branch, Research Triangle Park, NC, United States., Clark J; Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, United States., Midboe AM; Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, United States.; Stanford School of Medicine, Stanford, CA, United States.
Jazyk:	angličtina
Zdroj:	JMIR formative research [JMIR Form Res] 2021 Nov 09; Vol. 5 (11), pp. e27748. Date of Electronic Publication: 2021 Nov 09.
DOI:	10.2196/27748
Abstrakt:	Background: Cirrhosis, or scarring of the liver, is a debilitating condition that affects millions of US adults. Early identification, linkage to care, and retention of care are critical for preventing severe complications and death from cirrhosis. Objective: The purpose of this study is to conduct a preimplementation formative evaluation to identify factors that could impact implementation of the Population-Based Cirrhosis Identification and Management System (P-CIMS) in clinics serving patients with cirrhosis. P-CIMS is a web-based informatics tool designed to facilitate patient outreach and cirrhosis care management. Methods: Semistructured interviews were conducted between January and May 2016 with frontline providers in liver disease and primary care clinics at 3 Veterans Health Administration medical centers. A total of 10 providers were interviewed, including 8 physicians and midlevel providers from liver-related specialty clinics and 2 primary care providers who managed patients with cirrhosis. The Consolidated Framework for Implementation Research guided the development of the interview guides. Inductive consensus coding and content analysis were used to analyze transcribed interviews and abstracted coded passages, elucidated themes, and insights. Results: The following themes and subthemes emerged from the analyses: outer setting: needs and resources for patients with cirrhosis; inner setting: readiness for implementation (subthemes: lack of resources, lack of leadership support), and implementation climate (subtheme: competing priorities); characteristics of individuals: role within clinic; knowledge and beliefs about P-CIMS (subtheme: perceived and realized benefits; useful features; suggestions for improvement); and perceptions of current practices in managing cirrhosis cases (subthemes: preimplementation process for identifying and linking patients to cirrhosis care; structural and social barriers to follow-up). Overall, P-CIMS was viewed as a powerful tool for improving linkage and retention, but its integration in the clinical workflow required leadership support, time, and staffing. Providers also cited the need for more intuitive interface elements to enhance usability. Conclusions: P-CIMS shows promise as a powerful tool for identifying, linking, and retaining care in patients living with cirrhosis. The current evaluation identified several improvements and advantages of P-CIMS over current care processes and provides lessons for others implementing similar population-based identification and management tools in populations with chronic disease. (©Sarah J Javier, Justina Wu, Donna L Smith, Fasiha Kanwal, Lindsey A Martin, Jack Clark, Amanda M Midboe. Originally published in JMIR Formative Research (https://formative.jmir.org), 09.11.2021.)
Databáze:	MEDLINE
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