Frontline perspectives on adoption and non-adoption of care management tools for high-risk patients in primary care.

Autor: McGowan M; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, USA. Electronic address: michael.mcgowan3@va.gov., Rose D; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, USA., Paez M; Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, USA., Stewart G; Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, USA; Department of Management and Organizations, Tippie College of Business, University of Iowa, USA., Stockdale S; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA. Electronic address: Susan.Stockdale@va.gov.
Jazyk: angličtina
Zdroj: Healthcare (Amsterdam, Netherlands) [Healthc (Amst)] 2023 Dec; Vol. 11 (4), pp. 100719. Date of Electronic Publication: 2023 Sep 23.
DOI: 10.1016/j.hjdsi.2023.100719
Abstrakt: Background: Population health management tools (PHMTs) embedded within electronic health records (EHR) could improve management of high-risk patients and reduce costs associated with potentially avoidable emergency department visits or hospitalizations. Adoption of PHMTs across the Veterans Health Administration (VA) has been variable and previous research suggests that understaffed primary care (PC) teams might not be using the tools.
Methods: We conducted a retrospective content analysis of open-text responses (n = 1804) from the VA's 2018 national primary care personnel survey to, 1) identify system-level and individual-level factors associated with why clinicians are not using the tools, and 2) to document clinicians' recommendations to improve tool adoption.
Results: We found three themes pertaining to low adoption and/or tool use: 1) IT burden and administrative tasks (e.g., manually mailing letters to patients), 2) staffing shortages (e.g., nurses covering multiple teams), and 3) no training or difficulty using the tools (e.g., not knowing how to access the tools or use the data). Frontline clinician recommendations included automating some tasks, reconfiguring team roles to shift administrative work away from providers and nurses, consolidating PHMTs into a centralized, easily accessible repository, and providing training.
Conclusions: Healthcare system-level factors (staffing) and individual-level factors (lack of training) can limit adoption of PHMTs that could be useful for reducing costs and improving patient outcomes. Future research, including qualitative interviews with clinicians who use/don't use the tools, could help develop interventions to address barriers to adoption.
Implications: Shifting more administrative tasks to clerical staff would free up clinician time for population health management but may not be possible for understaffed PC teams. Additionally, healthcare systems may be able to increase PHMT use by making them more easily accessible through the electronic health record and providing training in their use.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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