Factors facilitating the implementation of a clinical decision support system in primary care practices: a fuzzy set qualitative comparative analysis
Abstract Background Understanding how to implement innovations in primary care practices is key to improve primary health care. Aiming to contribute to this understanding, we investigate the implementation of a clinical decision support system (CDSS) as part of the innovation fund project AdAM (01NV...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-10156-9 |
| _version_ | 1797647368316780544 |
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| author | Alexandra Piotrowski Jana Coenen Christian Rupietta Jale Basten Christiane Muth Sara Söling Viola Zimmer Ute Karbach Petra Kellermann-Mühlhoff Juliane Köberlein-Neu the AdAM study group |
| author_facet | Alexandra Piotrowski Jana Coenen Christian Rupietta Jale Basten Christiane Muth Sara Söling Viola Zimmer Ute Karbach Petra Kellermann-Mühlhoff Juliane Köberlein-Neu the AdAM study group |
| author_sort | Alexandra Piotrowski |
| collection | DOAJ |
| description | Abstract Background Understanding how to implement innovations in primary care practices is key to improve primary health care. Aiming to contribute to this understanding, we investigate the implementation of a clinical decision support system (CDSS) as part of the innovation fund project AdAM (01NVF16006). Originating from complexity theory, the practice change and development model (PCD) proposes several interdependent factors that enable organizational-level change and thus accounts for the complex settings of primary care practices. Leveraging the PCD, we seek to answer the following research questions: Which combinations of internal and external factors based on the PCD contribute to successful implementation in primary care practices? Given these results, how can implementation in the primary care setting be improved? Methods We analyzed the joint contributions of internal and external factors on implementation success using qualitative comparative analysis (QCA). QCA is a set-theoretic approach that allows to identify configurations of multiple factors that lead to one outcome (here: successful implementation of a CDSS in primary care practices). Using survey data, we conducted our analysis based on a sample of 224 primary care practices. Results We identified two configurations of internal and external factors that likewise enable successful implementation. The first configuration enables implementation based on a combination of Strong Inside Motivation, High Capability for Development, and Strong Outside Motivation; the second configuration based on a combination of Strong Inside Motivators, Many Options for Development and the absence of High Capability for Development. Conclusion In line with the PCD, our results demonstrate the importance of the combination of internal and external factors for implementation outcomes. Moreover, the two identified configurations show that different ways exist to achieve successful implementation in primary care practices. Trial registration AdAM was registered on ClinicalTrials.gov ( NCT03430336 ) on February 6, 2018. |
| first_indexed | 2024-03-11T15:16:17Z |
| format | Article |
| id | doaj.art-e407394b2b7f419eb1741640ece36445 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-11T15:16:17Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-e407394b2b7f419eb1741640ece364452023-10-29T12:18:46ZengBMCBMC Health Services Research1472-69632023-10-0123111310.1186/s12913-023-10156-9Factors facilitating the implementation of a clinical decision support system in primary care practices: a fuzzy set qualitative comparative analysisAlexandra Piotrowski0Jana Coenen1Christian Rupietta2Jale Basten3Christiane Muth4Sara Söling5Viola Zimmer6Ute Karbach7Petra Kellermann-Mühlhoff8Juliane Köberlein-Neu9the AdAM study groupCenter for Health Economics and Health Services Research, University of WuppertalJackstädt Center of Entrepreneurship and Innovation Research, University of WuppertalJackstädt Center of Entrepreneurship and Innovation Research, University of WuppertalDepartment of Medical Informatics, Biometry and Epidemiology, Ruhr University BochumDepartment of General Practice and Family Medicine, Medical School OWL, Bielefeld UniversityCenter for Health Economics and Health Services Research, University of WuppertalCenter for Health Economics and Health Services Research, University of WuppertalInstitute for Medical Sociology, Health Services Research and Rehabilitation Science, Department of Rehabilitation and Special Education, Faculty of Human Sciences, University of CologneBARMER Statutory Health InsuranceCenter for Health Economics and Health Services Research, University of WuppertalAbstract Background Understanding how to implement innovations in primary care practices is key to improve primary health care. Aiming to contribute to this understanding, we investigate the implementation of a clinical decision support system (CDSS) as part of the innovation fund project AdAM (01NVF16006). Originating from complexity theory, the practice change and development model (PCD) proposes several interdependent factors that enable organizational-level change and thus accounts for the complex settings of primary care practices. Leveraging the PCD, we seek to answer the following research questions: Which combinations of internal and external factors based on the PCD contribute to successful implementation in primary care practices? Given these results, how can implementation in the primary care setting be improved? Methods We analyzed the joint contributions of internal and external factors on implementation success using qualitative comparative analysis (QCA). QCA is a set-theoretic approach that allows to identify configurations of multiple factors that lead to one outcome (here: successful implementation of a CDSS in primary care practices). Using survey data, we conducted our analysis based on a sample of 224 primary care practices. Results We identified two configurations of internal and external factors that likewise enable successful implementation. The first configuration enables implementation based on a combination of Strong Inside Motivation, High Capability for Development, and Strong Outside Motivation; the second configuration based on a combination of Strong Inside Motivators, Many Options for Development and the absence of High Capability for Development. Conclusion In line with the PCD, our results demonstrate the importance of the combination of internal and external factors for implementation outcomes. Moreover, the two identified configurations show that different ways exist to achieve successful implementation in primary care practices. Trial registration AdAM was registered on ClinicalTrials.gov ( NCT03430336 ) on February 6, 2018.https://doi.org/10.1186/s12913-023-10156-9Primary careImplementationQualitative comparative analysisOrganizational behavior |
| spellingShingle | Alexandra Piotrowski Jana Coenen Christian Rupietta Jale Basten Christiane Muth Sara Söling Viola Zimmer Ute Karbach Petra Kellermann-Mühlhoff Juliane Köberlein-Neu the AdAM study group Factors facilitating the implementation of a clinical decision support system in primary care practices: a fuzzy set qualitative comparative analysis BMC Health Services Research Primary care Implementation Qualitative comparative analysis Organizational behavior |
| title | Factors facilitating the implementation of a clinical decision support system in primary care practices: a fuzzy set qualitative comparative analysis |
| title_full | Factors facilitating the implementation of a clinical decision support system in primary care practices: a fuzzy set qualitative comparative analysis |
| title_fullStr | Factors facilitating the implementation of a clinical decision support system in primary care practices: a fuzzy set qualitative comparative analysis |
| title_full_unstemmed | Factors facilitating the implementation of a clinical decision support system in primary care practices: a fuzzy set qualitative comparative analysis |
| title_short | Factors facilitating the implementation of a clinical decision support system in primary care practices: a fuzzy set qualitative comparative analysis |
| title_sort | factors facilitating the implementation of a clinical decision support system in primary care practices a fuzzy set qualitative comparative analysis |
| topic | Primary care Implementation Qualitative comparative analysis Organizational behavior |
| url | https://doi.org/10.1186/s12913-023-10156-9 |
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