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BACKGROUND/RATIONALE:
Over the last 3 years, the VA Cardiovascular Assessment Reporting and Tracking system for Cath Labs (CART-CL) has been developed and implemented in the 75 VA’s that have cardiac catheterization laboratories. As is common with clinical quality improvement projects and health information technology implementation, there is variation in the rate and degree of implementation of the system. Therefore, the goals of this project are to measure the variations in implementation of CART-CL across all 75 VA cath labs, and to evaluate the facilitators to successful implementation as well as the barriers to delayed and/or incomplete implementation.
OBJECTIVE(S):
Our objectives are to: (1) describe the rate and degree of implementation of CART-CL in the 75 VA cath labs; (2) combining quantitative and qualitative techniques, determine the clinician, technical, and system facilitators associated with timely and complete adoption of CART-CL; and (3) combining quantitative and qualitative techniques, identify the key barriers to complete adoption and ongoing use of the system.
METHODS:
This is a cross-sectional study of the facilitators and barriers in implementation and adoption of CART-CL in all 75 cath labs, using both quantitative and qualitative data sources. Using existing data from the CART-CL internal process database, which includes dates of first contact, initiaton and completion of installation, initiation of clinical use, as well as historical monthly procedural volumes for each cath lab site, we will quantitatively describe the speed of installation and adoption (days), degree of adoption as the proportion of staff cardiologists using CART-CL and proportion of cath lab procedure reports/month being generated using CART-CL, and the persistence of adoption as the proportion of monthly cath lab procedure reports generated using CART-CL over a 6+ month period for each of the 75 sites. To understand the perceptions of personnel involved in the installation and implementation at each CART-CL site, we are surveying two to three of the key clinical and technical staff at each of the 75 sites using a structured, web-based survey. In addition, we are using semi-structured qualitative interviews with a technical and clinical contact at 8 to 12 facilities to further elucidate facilitators and barriers of HIT installation and adoption.
FINDINGS/RESULTS:
In the first few months of this study, we have obtained data from the CART-CL internal process database to begin to describe the speed and the degree of both installation and adoption of CART-CL across VA cath labs. We have also developed both the structured, web-based survey and semi-structured, qualitative interview instruments. We are now beginning pilot testing of both survey instruments.
IMPACT:
We anticipate CART-CL may serve as a model of a national, HIT-based quality improvement initiative. Understanding key facilitators and barriers in the installation and adoption of CART-CL in VA cath labs, from both clinical and technical perspectives, may help to guide and improve the implementation process of future HIT-based quality improvement and patient safety initiatives.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Technology Development and Assessment
Keywords:
Cardiac procedures, Cardiovasc’r disease, Implementation
MeSH Terms:
Cardiovascular Diseases, Evaluation Studies
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