Synthesizing Lessons Learned Using Health Information Technology - 2011

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