Leveraging the Consolidated Framework for Implementation Research (CFIR) to Develop the American College of Rheumatology's Toolkit for Implementation of Rheumatoid Arthritis Outcome Measures in Clinical Practice: A Qualitative Study.
Catherine Nasrallah, Gabriela Schmajuk, Alicia Hamblin, Cherish Wilson, Emma Kersey, Cammie Young, Patti Katz, Puneet Bajaj, Christina Downey, Christie Bartels, JoAnn Zell, Maria I Danila, Sancia Ferguson, Jennifer L Barton, Kimberly DeQuattro, Jinoos Yazdany
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引用次数: 0
Abstract
Objective: Despite the recognized benefits of collecting rheumatoid arthritis (RA) outcomes measures, their use in routine care is inconsistent. Using the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews with United States rheumatologists and practice personnel to assess workflows, opportunities, and challenges in collecting RA outcome measures. Using insights from interviews, we developed the RA Measures Toolkit to enhance their utilization in clinical practice.
Methods: We invited 138 RISE registry practices and 5 academic medical centers with ≥ 30 patients eligible for RA outcome measures to participate in the study. Practices were classified based on their performance in quality payment programs. Recorded interviews were transcribed verbatim and analyzed thematically using deductive and inductive techniques. The findings were used to create the RA Measures Toolkit.
Results: We conducted 20 interviews with 38 participants across 20 practices. Key themes within the CFIR domains highlighted the challenges and best practices in RA outcome measure collection and included: 1) Process: the variability in practices' use of RA outcome measures and the importance of streamlined workflows, 2) Intervention: challenges of integrating PROs into electronic health records (EHRs), and 3) Individual characteristics: importance of clinic culture around quality improvement. Using this data, we developed the RA Toolkit, a multimedia online resource, featuring guidelines, best practices, and educational resources to improve the efficiency of current workflows and to enhance patient care.
Conclusion: This study identifies critical gaps in the collection of RA outcome measures in U.S. rheumatology practices and provides actionable recommendations and resources to address challenges via the RA Toolkit.
目的：尽管收集类风湿性关节炎（RA）结果指标的益处已得到公认，但其在常规护理中的应用却不一致。利用实施研究综合框架（CFIR），我们对美国的风湿病学家和医务人员进行了半结构化访谈，以评估收集 RA 结果指标的工作流程、机遇和挑战。利用访谈中获得的见解，我们开发了 RA 测量工具包，以提高其在临床实践中的利用率：我们邀请了 138 家 RISE 注册机构和 5 家学术医疗中心参与研究，这些机构都拥有≥ 30 名符合 RA 结果测量条件的患者。我们根据医疗机构在质量支付项目中的表现对其进行了分类。对访谈录音进行逐字转录，并采用演绎和归纳技术进行专题分析。研究结果被用于创建 RA 措施工具包：我们对 20 家医疗机构的 38 名参与者进行了 20 次访谈。CFIR 领域的关键主题突出了 RA 成果测量收集方面的挑战和最佳实践，包括1）过程：实践中使用 RA 结果测量的差异性以及简化工作流程的重要性；2）干预：将 PROs 整合到电子健康记录 (EHR) 中的挑战；以及 3）个体特征：围绕质量改进的诊所文化的重要性。利用这些数据，我们开发了 RA 工具包，这是一个多媒体在线资源，其中包括指南、最佳实践和教育资源，以提高当前工作流程的效率并加强患者护理：本研究确定了美国风湿病学实践中在收集 RA 结果指标方面存在的关键差距，并通过 RA 工具包提供了应对挑战的可行建议和资源。
期刊介绍：
Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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