Denise Hartnett Daudelin

A New Taxonomy for Stakeholder Engagement in Patient-Centered Outcomes Research

Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach.

The Potential of Training to Increase Acceptance and Use of Computerized Decision Support Systems for Medical Diagnosis

Objective: The goals of this study were to understand the reasons underlying the limited use of medical decision-support tools and to explore the potential of a computerbased tutorial to mitigate barriers to use. Background: Medical decision-support tools such the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACITIPI) have demonstrated statistical validity and clinical impact for patient safety but have seen limited adoption and use. Methods: The study developed a brief Web-based “demystifying” ACI-TIPI tutorial employing case-based training and valuated the effectiveness of that tutorial in changing self-reported attitudes and behaviors. Results: Clinicians using the tutorial reported greater understanding of how to use the ACITIPI score appropriately and increased confidence in the score. Case studies in the tutorial that provided examples of how to use the score for actual cases were rated as especially helpful. Conclusion: This study suggests that a primary barrier to the use of statistical decision support tools for patient diagnosis is lack of training or experience in combining a population-based numerical risk score with other diagnostic information about the individual patients case that is not considered in that score. The results of this study indicate that there is a potential for a relatively brief tutorial to increase acceptance and use of decision support tools for medical diagnosis. Application: These findings have the potential for the identification of methods to help clinicians learn how to use statistical and probabilistic information to better assess risk and to promote integration of decision support tools into medical decision making for improvement of patient safety.

The Massachusetts Emergency Medical Service Stroke Quality Improvement Collaborative, 2009–2012

Introduction Quality improvement collaboratives are a popular model used to address gaps between evidence-based practice and patient care. Little is known about use of such collaboratives in emergency medical services, particularly for improving prehospital stroke care. To determine the feasibility of using this approach to improve prehospital stroke care, we conducted a pilot study of the Emergency Medical Services Stroke Quality Improvement Collaborative. Methods Seventeen Massachusetts emergency medical service agencies participated in the quality improvement collaborative pilot project. We identified 5 prehospital stroke performance measures to assess the quality of prehospital care, guide collaborative activities, and monitor change in performance over time. During learning sessions, participants were trained in quality improvement and performance measurement, analyzed performance measure results, and shared successes and challenges. Focus groups were conducted to understand participants’ experiences with the collaborative. Results Participating emergency medical service agencies collected stroke performance measures on 3,009 stroke patients during the pilot study. Adherence to 4 of 5 performance measures increased significantly over time. Participants acknowledged that the collaborative provided them with an efficient and effective framework for stroke quality improvement and peer-learning opportunities. Conclusion As evidenced in Massachusetts, quality improvement collaboratives can be an effective tool to improve prehospital stroke care. The data collected, improvements made, participation of emergency medical service agencies, and positive experiences within the collaborative support the continued use of this approach.

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples

There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in‐person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies.

Improving Acceptance and Adoption of Informatics Tools: Acute Cardiac Care

Medical decision-support tools such as those for acute cardiac ischemia (ACI) (the ACI-Time-Insensitive Predictive Instrument [ACI-TIPI]) have demonstrated statistical validity and clinical impact for patient safety but have seen limited adoption and use by clinicians. The goals of this study were (1) to understand the ACI diagnosis decision process and to identify “barriers” to the acceptance and use of the ACI-TIPI by clinicians; and (2) to develop and test the effectiveness of a brief web-based “demystifying” ACI-TIPI tutorial in removing these barriers. The tutorial had a significant effect on many of these barriers with the tutorial-educated physician group reporting greater awareness and understanding of the ACI-TIPI risk-assessment score; more confidence in the score; and greater perceived usefulness, and use, of the score. The ultimate product is not only strategies for promoting use of the ACI-TIPI, but also validated methods for designing such informatics tools for adoption in a multitude of medical domains.