Recently, VHA has embarked on a program to launch an innovative re-design of clinical research by instituting point of care research (POCr) trials. The new innovation will require the adoption of new infrastructure and research processes. The goal of this study is to provide information that will ensure the success of the VA POCr program. This proposal will result in deliverables that will inform the design of marketing, education, implementation and informatics guidelines. The targets will be providers, patients, administrators and staff.
Specific Aim 1. Identify the barriers and facilitators to adoption of a POCr research innovation program. Assess the perceptions and attitudes of patients, providers, staff and administrators regarding privacy, patient-provider relationships, ethical issues, and concerns regarding the equivalence of care, workflow, and barriers to patient enrollment, implementation, and CPRS functionality Specific Aim 2. Produce guidelines for VHA regarding implementation of POCr, focusing on: 1) effective implementation strategies and workflow modifications;2) tailored recommendations for overcoming identified barriers to adoption;3) requirements for marketing and education content for providers;4) requirements for marketing and education for patients;5) institutional policy requirements, and 6) key functional requirements for utilizing CPRS to support POCr patient identification, tracking and decision support. Methods: Cognitive interviewing of patients, providers, staff and administrators will be conducted at 2 VA Vanguard sites already using POCr followed by 3 additional sites to understand basic issues, concerns, language and workflow patterns relevant to implementation of POCr. Information from these interviews will be used to construct relevant vignettes and a focus group script. Following piloting, 30 focus groups (1 for patients and another for providers/staff/ administrators) will be conducted at 15 VA sites selected for diversity in size and geography. Qualitative analysis will be conducted on transcribed audio-tapes from the focus groups. Key issues for analysis will likely include the impact of POCr on provider-patient relationships, workflow, privacy, quality of care and other issues.
Aim 2 will use feedback and discussion with stakeholders to design marketing, education, and implementation guidelines for dissemination.
The goal of this study is to assess VHA patient, provider, staff and administrator perceptions of utilizing Point of Care research (POCr). POCr allows randomization for equivalent options during clinical care in VHA to compare effectiveness and enhance evidence-based medical decision making. Cognitive interviews and focus groups conducted with VHA patients and healthcare providers will assess potential benefits, barriers, appropriate use criteria and strategies for overcoming barriers in implementation. Deliverables include guideline recommendation for education, marketing, implementation, policy deployment and CPRS enhancements.
