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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Statins | Research article

Developing a toolkit to implement the Statin Choice Conversation Aid at scale: application of a work reduction model

Authors: Aaron L. Leppin, Kasey R. Boehmer, Megan E. Branda, Nilay D. Shah, Ian Hargraves, Sara Dick, Glyn Elwyn, Henry H. Ting, Siqin Ye, Ryan Gilles, Marghoob Abbas, Alex Alexander, Victor M. Montori

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Guidelines recommend shared decision making (SDM) for determining whether to use statins to prevent cardiovascular events in at-risk patients. We sought to develop a toolkit to facilitate the cross-organizational spread and scale of a SDM intervention called the Statin Choice Conversation Aid (SCCA) by (i) assessing the work stakeholders must do to implement the tool; and (ii) orienting the resulting toolkit’s components to communicate and mitigate this work.

Methods

We conducted multi-level and mixed methods (survey, interview, observation, focus group) characterizations of the contexts of 3 health systems (n = 86, 84, and 26 primary care clinicians) as they pertained to the impending implementation of the SCCA. We merged the data within implementation outcome domains of feasibility, appropriateness, and acceptability. Using Normalization Process Theory, we then characterized and categorized the work stakeholders did to implement the tool. We used clinician surveys and IP address-based tracking to calculate SCCA usage over time and judged how stakeholder effort was allocated to influence outcomes at 6 and 18 months. After assessing the types and impact of the work, we developed a multi-component toolkit.

Results

At baseline, the three contexts differed regarding feasibility, acceptability, and appropriateness of implementation. The work of adopting the tool was allocated across many strategies in complex and interdependent ways to optimize these domains. The two systems that allocated the work strategically had higher uptake (5.2 and 2.9 vs. 1.1 uses per clinician per month at 6 months; 3.8 and 2.1 vs. 0.4 at 18 months, respectively) than the system that did not. The resulting toolkit included context self-assessments intended to guide stakeholders in considering the early work of SCCA implementation; and webinars, EMR integration guides, video demonstrations, and an implementation team manual aimed at supporting this work.

Conclusions

We developed a multi-component toolkit for facilitating the scale-up and spread of a tool to promote SDM across clinical settings. The theory-based approach we employed aimed to distinguish systems primed for adoption and support the work they must do to achieve implementation. Our approach may have value in orienting the development of multi-component toolkits and other strategies aimed at facilitating the efficient scale up of interventions.

Trial registration

Appendix
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Metadata
Title
Developing a toolkit to implement the Statin Choice Conversation Aid at scale: application of a work reduction model
Authors
Aaron L. Leppin
Kasey R. Boehmer
Megan E. Branda
Nilay D. Shah
Ian Hargraves
Sara Dick
Glyn Elwyn
Henry H. Ting
Siqin Ye
Ryan Gilles
Marghoob Abbas
Alex Alexander
Victor M. Montori
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Statins
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4055-8

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