title: Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI.
abstract: This paper evaluates the role of facilitation in the successful implementation of Computerized Decision Support (CDS). Facilitation processes include education, specialized computerized decision support, and work process reengineering. These techniques, as well as modeling and feedback enhance self-efficacy, which we propose is one of the factors that mediate the effectiveness of any CDS. In this study, outpatient clinics implemented quality improvement (QI) projects focused on improving geriatric care. Quality Improvement is the systematic process of improving quality through continuous measurement and targeted actions. The program, entitled "Advancing Geriatric Education through Quality Improvement" (AGE QI), consisted of a 6-month, QI based, intervention: (1) 2h didactic session, (2) 1h QI planning session, (3) computerized decision support design and implementation, (4) QI facilitation activities, (5) outcome feedback, and (6) 20h of CME. Specifically, we examined the impact of the QI based program on clinician's perceived self-efficacy in caring for older adults and the relationship of implementation support and facilitation on perceived success. The intervention was implemented at 3 institutions, 27 community healthcare system clinics, and 134 providers. This study reports the results of pre/post surveys for the forty-nine clinicians who completed the full CME program. Self-efficacy ratings for specific clinical behaviors related to care of older adults were assessed using a Likert based instrument. Self-ratings of efficacy improved across the following domains (depression, falls, end-of-life, functional status and medication management) and specifically in QI targeted domains and were associated with overall clinic improvements.
authors: Geriatric Research, Education, and Clinical Center (GRECC), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States; Department of Biomedical Informatics, University of Utah School of Medicine, United States. Electronic address: charlene.weir@hsc.utah.edu.
authors: Charlene
authors: C
authors: Weir
authors: Department of Internal Medicine, Division of Geriatrics, University of Utah School of Medicine, United States; Intermountain Healthcare, Salt Lake City, UT, United States.
authors: Cherie
authors: C
authors: Brunker
authors: Geriatric Research, Education, and Clinical Center (GRECC), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States.
authors: Jorie
authors: J
authors: Butler
authors: Geriatric Research, Education, and Clinical Center (GRECC), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States; Department of Internal Medicine, Division of Geriatrics, University of Utah School of Medicine, United States.
authors: Mark A
authors: MA
authors: Supiano
mesh_terms: D003071:Cognition; D020000:Decision Support Systems, Clinical; D005246:Feedback; D006801:Humans; D019359:Knowledge; D058996:Quality Improvement; D011795:Surveys and Questionnaires
keywords: Cognition; Decision support; Geriatrics; Implementation science; Psychology; Self-efficacy