User-Centered Framework for Implementation of Technology (UFIT): Development of an Integrated Framework for Designing Clinical Decision Support Tools Packaged With Tailored Implementation Strategies.

Autor:	Ray J; Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States., Finn EB; Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States., Tyrrell H; Academic Pediatric Association, McLean, VA, United States., Aloe CF; Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States., Perrin EM; Department of Pediatrics, Johns Hopkins University School of Medicine and School of Nursing, Baltimore, MD, United States., Wood CT; Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States., Miner DS; Departments of Pediatrics and Internal Medicine, East Carolina University, Greenville, NC, United States., Grout R; Department of Pediatrics, Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN, United States., Michel JJ; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States., Damschroder LJ; Implementation Pathways, LLC and Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, United States., Sharifi M; Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States.
Jazyk:	angličtina
Zdroj:	Journal of medical Internet research [J Med Internet Res] 2024 May 21; Vol. 26, pp. e51952. Date of Electronic Publication: 2024 May 21.
DOI:	10.2196/51952
Abstrakt:	Background: Electronic health record-based clinical decision support (CDS) tools can facilitate the adoption of evidence into practice. Yet, the impact of CDS beyond single-site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogeneous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts. Objective: This study aims to develop and apply a framework to guide tailoring and implementing CDS across diverse clinical settings. Methods: In preparation for a multisite trial implementing CDS for pediatric overweight or obesity in primary care, we developed the User-Centered Framework for Implementation of Technology (UFIT), a framework that integrates principles from user-centered design (UCD), human factors/ergonomics theories, and implementation science to guide both CDS adaptation and tailoring of related implementation strategies. Our transdisciplinary study team conducted semistructured interviews with pediatric primary care clinicians and a diverse group of stakeholders from 3 health systems in the northeastern, midwestern, and southeastern United States to inform and apply the framework for our formative evaluation. Results: We conducted 41 qualitative interviews with primary care clinicians (n=21) and other stakeholders (n=20). Our workflow analysis found 3 primary ways in which clinicians interact with the electronic health record during primary care well-child visits identifying opportunities for decision support. Additionally, we identified differences in practice patterns across contexts necessitating a multiprong design approach to support a variety of workflows, user needs, preferences, and implementation strategies. Conclusions: UFIT integrates theories and guidance from UCD, human factors/ergonomics, and implementation science to promote fit with local contexts for optimal outcomes. The components of UFIT were used to guide the development of Improving Pediatric Obesity Practice Using Prompts, an integrated package comprising CDS for obesity or overweight treatment with tailored implementation strategies. Trial Registration: ClinicalTrials.gov NCT05627011; https://clinicaltrials.gov/study/NCT05627011. (©Jessica Ray, Emily Benjamin Finn, Hollyce Tyrrell, Carlin F Aloe, Eliana M Perrin, Charles T Wood, Dean S Miner, Randall Grout, Jeremy J Michel, Laura J Damschroder, Mona Sharifi. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 21.05.2024.)
Databáze:	MEDLINE
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