Synthesizing Lessons Learned Using Health Information Technology (South Carolina)

Project Final Report (PDF, 182.32 KB) Disclaimer

Project Details - Ended

Project Categories

Summary:

The Practice Partner Research Network (PPRNet), a practice-based research network consisting of more than 224 physician practices using a common electronic medical record (EMR), established a theoretically informed framework for translating research into practice (TRIP) in small- to medium-sized primary care practices. The PPRNet-TRIP Quality Improvement (QI) model included three components: an intervention model; an improvement model; and a practice development model that helps practices implement strategies to improve selected performance measures. 

This project synthesized what was learned from PPRNet-TRIP regarding how to use health information technology (IT) to improve quality in primary care practices. The project used mixed-methods, including secondary data analysis of seven PPRNet studies funded since 2001, and interviews of practice members participating in these studies. 

The specific aims of this project were to:

  • Complete a mixed-methods secondary analysis to synthesize findings related to improving quality using health IT in primary care across seven nationally funded PPRNet initiatives.
  • Examine current perspectives of PPRNet-TRIP study practice participants related to developing and sustaining QI efforts and team development for an increasingly active health care delivery role through robust EMR implementation.
  • Integrate findings from PPRNet’s previous studies with the current perspectives of practice representatives to refine the overarching theory-based PPRNet-TRIP QI model.

Secondary analysis data included field notes and observations at practice site visits, network meetings, memos, correspondence, and practice member interviews. All data was merged within a database for qualitative analysis. A cross-case analysis generated important themes, provided new insights, and generated new hypotheses about factors that improve the quality of care through the use of EMRs. The framework developed included four key concepts found to drive improvement efforts: 1) develop a team care practice; 2) adapt and use health IT tools; 3) transform practice culture and quality; and 4) activate patients. This framework was reviewed and validated by practice members and co-investigators of the project. The new framework provides practical guidance for practices that are undertaking efforts to achieve meaningful use, obtain patient-centered medical home recognition, and create paths for improved financial resources pertaining to quality improvement in primary care practice.

Synthesizing Lessons Learned Using Health Information Technology - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-268: Small Research Grant to Improve Health Care Quality Through Health Information Technology (IT) (R03)
  • Grant Number: 
    R03 HS 018830
  • Project Period: 
    May 2010 – April 2013
  • AHRQ Funding Amount: 
    $99,861
  • PDF Version: 
    (PDF, 274.92 KB)

Summary: Over the past decade, the Practice Partner Research Network (PPRNet), a practice-based research network consisting of more than 224 physician practices, has established a theoretically informed framework for translating research into practice (TRIP) in small-to-medium-sized primary care practices that use the Practice Partner® electronic medical record (EMR). The PPRNet-TRIP Quality Improvement (QI) model has three components— intervention, improvement, and practice development—that assist practices with implementation of QI measures.

This project conducted an evaluation of the mixed-methods data and lessons learned from a decade of PPRNet-TRIP research. The experience of PPRNet research participants and researchers enhanced the understanding of the PPRNet-TRIP components and how they improved primary care quality. The cross- case analyses conducted through this research generated important themes, provided new insights, and generated new hypotheses about factors that improve the quality of care through the use of EMRs.

Each of seven nationally funded PPRNet initiatives was reviewed for new interpretations and previously unidentified concepts. All source data for each project was embedded into NVivo 8.0 qualitative data analysis software for analyses. The research team read, re-read, and coded the full set of data using each whole project document or component.

Using the insight gleaned from the secondary analysis across all the studies and in collaboration with the PPRNet research team and the expert advisory panel, the research team developed a semi-structured interview guide to examine the perspectives of practice participants who have been engaged in previous PPRNet research. This interview guide was cognitively pre-tested with a small sample of practice participants to ensure that participants understood and could articulate the meaning of each question. Participants for the interviews on sustainability, maintenance, and team development were recruited from PPRNet practices that have participated in past studies.

Finally, by identifying the patterns transcending the individual projects, the project team reined and validated the PPRNet-TRIP QI model and its three components. This project combined observation data from site visits; group and individual interviews with practice participants; interactions of practice liaisons at best-practice network meetings; and ongoing correspondence in conjunction with quantitative practice performance data on the speciic measures related to each particular study to identify strategies implemented and barriers and facilitators of QI efforts by practices using EMRs. The secondary analyses of the primary indings in a context separate from the individual study, using “immersion and crystallization,” allowed new interpretations and learning about how the research team and the primary care practices within the research network have evolved to improve quality while implementing health information technology.

Specific Aims:

  • Complete a mixed-methods secondary analysis to synthesize indings related to improving quality using health information technology in primary care across seven nationally funded PPRNet initiatives. (Achieved) 
  • Examine current perspectives of PPRNet-TRIP study practice participants related to developing and sustaining QI efforts and team development for an increasingly active health care delivery role through robust EMR implementation. (Achieved) 
  • Integrate indings from PPRNet’s previous studies with the current perspectives of practice representatives to reine the overarching theory-based PPRNet-TRIP QI model. (Achieved) 

2012 Activities: Dr. Nemeth completed all major activities, analyzed data, and began developing a manuscript. The current perspectives of PPRNet participants related to developing and sustaining QI and team development were explored at the PPRNet meeting. The interview tool was pre-tested with providers at four practices, who demonstrated that they understood the questions and were able to inform them. In the meeting, practice members offered perspectives related to the new model, including development for QI using health information technology (IT), role redesign, and staff development.

Followup with selected participants explored themes to search for speciic examples that were not previously found within other data sources. Several telephone interviews with PPRNet members provided insight on how practices develop their teams, activate patients, and adapt and use health IT tools.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track and the budget spending is on target. The project is using a 1-year no-cost extension period for additional review of data analysis and manuscript development.

Preliminary Impact and Findings: The 134 primary care practices participating in PPRNet research studies established a collaborative learning community where practices demonstrated new ways to use health IT and their staff. Four main concepts were noted: 1) develop a team care practice; 2) adapt and use health IT tools; 3) transform practice culture and quality; and 4) activate patients.

Target Population: General

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Synthesis and Dissemination

Synthesizing Lessons Learned Using Health Information Technology - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-268: Small Research Grant to Improve Health Care Quality through Health Information Technology (IT) (R03)
  • Grant Number: 
    R03 HS 018830
  • Project Period: 
    May 2010 - April 2012
  • AHRQ Funding Amount: 
    $99,861
  • PDF Version: 
    (PDF, 175.43 KB)

Summary: Over the past decade, the Practice Partner Research Network (PPRNet), a practice-based research network consisting of more than 224 physician practices, has established a theoreticallyinformed framework for translating research into practice (TRIP) in small- to medium-sized primary care practices that use the Practice Partner(R) electronic medical record (EMR). The PPRNet-TRIP Quality Improvement (QI) model has three components: an intervention model, an improvement model, and a practice development model that assists practices with implementation of QI measures.

This project is conducting an evaluation of the mixed-methods data and lessons learned from a decade of PPRNet-TRIP research. The experience of PPRNet research participants and researchers will enhance understanding of the PPRNet-TRIP components and how they can improve primary care quality. The cross-case analyses conducted through this research will generate important themes, provide new insights, and generate new hypotheses about factors that improve the quality of care through the use of EMRs.

Each project is being reviewed individually for new interpretations and previously unidentified concepts. All source data for each project will be embedded into NVivo 8.0 - qualitative data analysis software - for analyses. Dr. Nemeth and her research team will read the full set of data for each project using each whole document or component, and will re-read and code.

Using the new insights developed through the secondary analysis across all the studies, a semi-structured interview guide will be developed in collaboration with the PPRNet research team and the expert advisory panel to examine the perspectives of practice participants who have been engaged in previous PPRNet research. This interview guide will be cognitively pre-tested with a small sample of practice participants to ensure that the meanings of the questions are understood and that participants can articulate what the questions mean. Participants for the interviews on sustainability, maintenance, and team development will be recruited from PPRNet practices that have participated in past studies.

Finally, by identifying the patterns transcending the individual projects, the project team will refine and validate the PPRNet-TRIP QI model and its three components. Using the combined observation data from practice site visits, group and individual interviews with practice participants, interactions of practice liaisons at best-practice network meetings, and ongoing correspondence in conjunction with quantitative practice performance data on the specific measures related to each particular study, this project will identify strategies implemented and the barriers and facilitators of QI efforts by practices using EMRs. The secondary analyses of the primary findings in a context separate from the individual study, using "immersion and crystallization," will allow new interpretations and learning about how the research team and the primary care practices within the research network have evolved to improve quality while implementing health information technology.

Specific Aims:

  • Complete a mixed-methods secondary analysis to synthesize findings related to improving quality using health information technology in primary care across seven nationally-funded PPRNet initiatives. (Achieved)
  • Examine current perspectives of PPRNet-TRIP study practice participants related to developing and sustaining QI efforts and team development for an increasingly active health care delivery role through robust EMR implementation. (Ongoing)
  • Integrate findings from PPRNet's previous studies with the current perspectives of practice representatives to refine the overarching theory-based PPRNet-TRIP QI model. (Ongoing)

2011 Activities: A preliminary refinement of the PPRNet-TRIP QI model resulted in the 12 initial concepts being reduced to four overarching themes that reflect the evolution of practice transformation using health information technology (IT) to improve quality: 1) developing a care practice team; 2) adapting and using health IT tools; 3) transforming the practice culture and quality; and 4) activating patients.

The refined model concepts have established internal validity and four practices provided evidence to support that this model adds to the learning and development of their practices while using health IT to improve quality. As the interviews are completed and analyzed, additional refinement of the model will occur.

The four concepts exemplified in the synthesized model continue to hold validity, and have streamlined two previous models to create a reference for the key steps involved in practice transformation for improving quality using health IT. Data analysis from discussions with practice members confirmed that there are variations in how this is implemented but the broad categories hold true. Continued evaluation with this model will ensure saturation of these concepts and that no premature conclusions are finalized.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track and the project budget spending is roughly on target.

Preliminary Impact and Findings: The project has no findings to date.

Target Population: General

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Synthesis and Dissemination

Synthesizing Lessons Learned Using Health Information Technology - 2010

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-268: Small Research Grant to Improve Health Care Quality through Health Information Technology (IT) (R03)
  • Grant Number: 
    R03 HS 018830
  • Project Period: 
    May 2010 – April 2012
  • AHRQ Funding Amount: 
    $99,861
  • PDF Version: 
    (PDF, 370.56 KB)


Target Population: Not Applicable

Summary: Over the past decade, the Practice Partner Research Network (PPRNet) has established a theoretically-informed framework for translating research into practice (TRIP) in small- to medium- sized primary care practices that use the Practice Partner® electronic medical record (EMR). The PPRNet-TRIP Quality Improvement (QI) Model has three components: an intervention model, an improvement model, and a practice development model that assists practices with implementation of QI measures.

This project is conducting an evaluation of the mixed-methods data and lessons learned from a decade of PPRNet-TRIP research. The experience of PPRNet research participants and researchers will enhance understanding of the PPRNet-TRIP components and how they can improve primary care quality. The cross-case analyses conducted through this research will generate important themes, provide new insights, and generate new hypotheses about factors that improve the quality of care through the use of EMRs.

Each project is being reviewed individually for new interpretations and discovery of concepts not previously identified. All source data for each project will be embedded into NVivo 8.0 (qualitative data analysis software) for analyses. The full set of data for each project will be read by Dr. Nemeth using each whole document or component, then re-read, and coded by Dr. Nemeth.

Using the new insights developed through the secondary analysis across all of the studies, a semi-structured interview guide will be developed in collaboration with the PPRNet research team and the expert advisory panel to examine the perspectives of practice participants who have been engaged in previous PPRNet research. This interview guide will be cognitively pre-tested with a small sample of practice participants to ensure that the meanings of the questions are understood consistently, and that participants can articulate what the questions mean. Participants for the interviews on sustainability, maintenance, and team development will be recruited from PPRNet practices that have participated in past studies.

Finally, by identifying the patterns transcending the individual projects, the project team will refine and validate the PPRNet-TRIP QI model and its three components: intervention, improvement, and practice development. Using the combined observation data from practice site visits, group and individual interviews with practice participants, interactions of practice liaisons at best-practice network meetings, and ongoing correspondence in conjunction with quantitative practice performance data on the specific measures related to each particular study, this project will identify strategies implemented and the barriers and facilitators of QI efforts by practices using EMRs. The secondary analyses of the primary findings in a context separate from the individual study, using “immersion and crystallization,” will allow new interpretations and learning about how the research team and the primary care practices within the research network have evolved to improve quality while implementing health information technology.

Specific Aims:
  • Complete a mixed-methods secondary analysis to synthesize findings related to improving quality using health information technology in primary care across seven nationally-funded PPRNet initiatives. (Ongoing)
  • Examine current perspectives of PPRNet-TRIP study practice participants related to developing and sustaining QI efforts and team development for an increasingly active health care delivery role through robust EMR implementation. (Ongoing)
  • Integrate findings from PPRNet’s previous studies with the current perspectives of practice representatives to refine the overarching theory-based “PPRNet-TRIP QI Model.” (Ongoing)

2010 Activities: The primary focus of this year was the first aim, which will inform the second and third aims, listed above. Mixed-methods data from three of the projects were reviewed during this period, including Colorectal Cancer Screening in Primary Care; Implementation and Evaluation of Electronic Standing Orders; and Medication Safety-Translating Research into Practice. In the review of these data, concepts were clarified and will be compared to the other studies. Data were extracted from a variety of sources including e-mail, meeting notes, site visit evaluations, focus groups, and interviews for analyses within the NVivo database.

As these three studies were recently completed during the reporting period, the primary qualitative analyses had fresh insight towards "newer concepts" that were not part of the original PPRNet models. Manuscripts pertaining to these most recent studies were revised, refined, clarified, and submitted for publication. Ongoing use of the NVivo database will be used to complete the secondary analyses of the seven studies. Preliminary revision of conceptual framework was initiated and will be tested for validity.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): This project is in the start-up phase and is meeting its aims. Spending is roughly on target.

Preliminary Impact and Findings: The project has no findings to date.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Synthesis and Dissemination

Synthesizing Lessons Learned Using Health Information Technology - Final Report

Citation:
Nemeth L. Synthesizing Lessons Learned Using Health Information Technology - Final Report. (Prepared by the Medical University of South Carolina under Grant No. R03 HS018830). Rockville, MD: Agency for Healthcare Research and Quality, 2013. (PDF, 182.32 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: 
Document Type: 
Population: 
This project does not have any related resource.
This project does not have any related survey.
This project does not have any related project spotlight.
This project does not have any related survey.
This project does not have any related story.
This project does not have any related emerging lesson.