Qualitative evaluation to explain success of multifaceted technology-driven hypertension intervention.
OBJECTIVE
This study sought to examine the implementation of an electronic health record-based intervention to improve quality of hypertension care in community health centers. The primary goal was to use qualitative analysis to explain how different components of the intervention contributed to positive patient-level outcomes.


METHODS
Qualitative process evaluation.


METHODS
The intervention included alerts, order sets, templates, clinical reminder algorithms, and provider performance feedback. Semi-structured interviews were conducted with primary care providers before (n = 16) and after (n = 16) intervention, and with key staff and leadership involved in the implementation (n = 6). The research team applied an iterative systematic qualitative coding process to identify salient themes. Several constructs from IT implementation theories guided the analysis.


RESULTS
The analysis focused on: (1) satisfaction and perceived usefulness of intervention components, (2) perceived proximal changes resulting from intervention, and (3) perceived facilitators of change. Different participants found different components useful. Proximal impact manifested in multiple ways (eg, more aggressive follow-up appointments and prescribing) and in increased overall attention to hypertension. Facilitators of success included leadership, organizational culture, provider engagement, rigorous implementation process, framing of intervention as quality improvement (QI), and health center capacity to process data.


CONCLUSIONS
We attribute the success of the intervention to a multifaceted approach where the combination of multiple intervention components resulted in across the-board change in hypertension care practices. In contrast with research that attempts to isolate the impact of circumscribed health information technology (HIT) tools, our experience suggests that HIT can achieve success in patient outcomes when rigorously implemented as a multifaceted intervention and framed as QI activity.
Department of Clinical Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY 10032, USA. mm994@columbia.edu
Mari
M
Millery
Donna
D
Shelley
Daren
D
Wu
Pamela
P
Ferrari
Tuo-Yen
TY
Tseng
Helene
H
Kopal
D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use; D057286:Electronic Health Records / Q000295:instrumentation*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008490:Medical Informatics / Q000295:instrumentation* / Q000379:methods / Q000458:organization & administration; D015279:Organizational Culture; D017060:Patient Satisfaction; D036301:Qualitative Research
D000959:Antihypertensive Agents