Assistant Professor University of Utah University of Utah Salt Lake City, Utah, United States
Background: Technology-based care coordination tools are increasingly prevalent in the care of children with medical complexity (CMC), but little is known about how to successfully implement these technologies into clinical care.
Objective: To evaluate the implementation of GoalKeeper (GK), an Internet-based goal-centered care plan for CMC.
Design/Methods: We used the Consolidated Framework for Implementation Research (CFIR) to explore barriers and facilitators to implementation of GK as part of a clinical trial of GK in ambulatory clinics at a children’s hospital (NCT03620071). Provider eligibility: MD, DO, NP at participating clinics. Parent eligibility: ≥18 years, English-speaking, home Internet access, with a CMC <12 years. All participants used GK in an initial clinic visit and for 3 months after. We conducted pre-implementation focus groups and post-implementation semi-structured exit interviews using the CFIR interview guide. Participant exit surveys assessed GK feasibility and acceptability on a 5-point Likert scale. For each interview, 3 independent coders used content analysis and serial coding reviews based on the CFIR qualitative analytic plan and assigned quantitative ratings to each CFIR construct (-2: strong barrier to +2: strong facilitator).
Results: Pre-implementation focus groups included 2 parents (1 male, 1 female) and 3 providers (1 complex care, 1 clinical informatics, and 1 neurology). From focus groups, we developed 3 implementation strategies: education (parents: 5-min demo, providers: 30-min tutorial and 5-min video on use in a clinic visit), tech support (in-person, virtual), and automated email reminders for parents. For implementation (4/1/19-12/21/20), we enrolled 11 providers (7 female, 5 complex care) and 26 parents (mean age 39.1 years (SD 7.6), 76% female, 46% Caucasian and 42% Hispanic, 80% ≥ some college). One parent-provider pair did not use GK in the clinic visit and few used GK after the visit. In 13 parent and 7 provider exit interviews, key facilitators were: parents and providers value shared goal-setting, GK’s web-accessibility and email reminders (parents), and GK’s ability to set long-term goals and use at the end of visits (providers). A key barrier was GK’s lack of integration into the electronic health record (EHR) or patient portal. Most parents (12/13) and providers (6/7) would recommend GK to their peers. Conclusion(s): Family-centered technologies like GK are feasible and acceptable for care of CMC, but sustained use depends on integration into EHRs.
Table 1. Parent characteristics
Table 2. Provider characteristics
Table 3. Barriers and facilitators to implementation
Table 4. CFIR ratings by subdomain and participant type
Authors/Institutions: Jody L. Lin, University of Utah, Salt Lake City, Utah, United States; Bernd Huber, Harvard University, Cambridge, Massachusetts, United States; Ofra Amir, Technion Israel Institute of Technology, Haifa, Haifa, Israel; Sebastian Gehrmann, Harvard University, Cambridge, Massachusetts, United States; Krzysztof Gajos, Harvard University, Cambridge, Massachusetts, United States; Steven M. Asch, Stanford University School of Medicine, Stanford, California, United States; Barbara Grosz, Harvard University, Cambridge, Massachusetts, United States; Lee M. Sanders, Stanford University, Stanford, California, United States
.jpg "Jody L. Lin, MD, MS photo")
