Feed forward systems for patient participation and provider support: adoption results from the original US context to Sweden and beyond.
BACKGROUND
This is a study of 2 clinical feed forward systems (FFSs) situated in different contexts: in the United States, where the system was developed, and in Swedish clinical settings, where it was first adopted. Both systems were identified as clinically successful despite differing contexts, and the objective of this study is to understand what essential properties determined their success.


METHODS
In our search for essential properties of the FFS, we used acceptance, use, and utility as indicators in questionnaires and interviews of patients and providers. Properties were identified as essential if they enabled reinforcing loops favorable for patients, providers, or both at clinical encounters.


RESULTS
A total of 44 patients participated in each context, along with 13 providers from the United States and 6 providers from the Swedish clinics. In the patient questionnaire, a majority of patients rated their impression of the FFS as excellent to good (United States: 84%, Sweden: 96%, P < .001). Interviews with both patients and providers indicated that the FFS patient overview displaying structured data previous to the clinical encounter is favorable. These essential properties enabled patient involvement through engagement, education, and communication with the provider, who appreciated them as time-saving for managing data and as decision support.


CONCLUSIONS
Despite distinctly different contexts and locally adapted content, essential properties that induced successful patient participation and provider support were identified as universal in the FFSs. Thus, further spread of the FFS may be enabled to accomplish patient-centered care and improved clinical information and quality management.
Medical Management Centre (MMC) Unit, Department of Learning Informatics, Management & Ethics (LIME), Karolinska Institutet, and Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. helena.hvitfeldt@ki.se
Helena
H
Hvitfeldt
Cheryl
C
Carli
Eugene C
EC
Nelson
Dawne M
DM
Mortenson
Birgit A
BA
Ruppert
Staffan
S
Lindblad
D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003142:Communication; D006801:Humans; D009513:New Hampshire; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods*; D011369:Professional-Patient Relations; D012017:Referral and Consultation; D012219:Rheumatology; D011795:Surveys and Questionnaires; D013548:Sweden; D014481:United States