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Article Title

Fidelity Evaluation of the Cardiometabolic Solution, CM-SHARE: Usage and User Acceptance

Publication Date

8-10-2017

Keywords

cardiovascular disease, program evaluation, communication, patients, providers, evaluation research, diabetes, qualitative research, dissemination and implementation of innovations, quality improvement

Abstract

Background: For implementation of an optional-use population health management tool for providers, several factors affect adoption and contribute to continued use. We evaluated providers’ fidelity to such a tool in a cohort of primary care patients with cardiometabolic (CM) conditions (diabetes, hypertension, dyslipidemia).

Methods: We implemented a CM eHealth management tool (CM-SHARE) at two primary care clinics in a large health care system in Northern California. The tool was designed to improve visit preparation and patient engagement. Quantitative data were procured from electronic health records (EHR) and from the app. Qualitative data were obtained from user-feedback interviews. CM patient encounters were matched to CM-SHARE launches, and practice characteristics were recorded for each clinician.

Results: Out of 6,184 scheduled encounters in the study period, 4,952 (80%) were made by CM patients, for whom CM-SHARE was launched 26% of the time. Of the CM patients with encounters, 692 (14%) had a CM condition as the primary diagnosis for the visit. Usage for this group was higher (42%). Launch rates varied by practice type: scribe model (team-based) had 57% usage; traditional model (providers working alone) had 21% usage. Usage dropped significantly from early morning to pre-lunch (30% to 22%, P < 0.01) and from midafternoon to evening (28% to 20%, P < 0.01). Providers reported using CM-SHARE for patients with: CM history, borderline lab values, weight issues, and multiple medications or labs. Other reported factors affecting usage included: lack of reminders to launch, inability to place orders or write notes, and toggling between the EHR and CM-SHARE on one screen. Providers used graphs (42%), trends (11%) and progress notes (8%) for patient education.

Conclusion: CM-SHARE was launched a quarter of the time for CM patients and more than 40% of the time for CM-specific visits. Providers working alone were less likely to use CM-SHARE. Providers appear to fall behind on their schedule and “catch up” during the lunch break. Providers reported spending less time navigating the EHR for graphs. Simple visuals improved patient understanding and patient-provider conversation. Overall, providers were engaged in the process and enthusiastic about future releases.

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