Author:
Piotrowski Alexandra,Coenen Jana,Rupietta Christian,Basten Jale,Muth Christiane,Söling Sara,Zimmer Viola,Karbach Ute,Kellermann-Mühlhoff Petra,Köberlein-Neu Juliane,van den Akker Marjan,Beckmann Till,Brandt Benjamin,Brünn Robin,Chapidi Kiran,Dinh Truc Sophia,Düvel Lara,Flaig Benno,Flume Mathias,Gerlach Ferdinand M.,Glasziou Paul,Gonzalez-Gonzalez Ana Isabel,Grandt Daniel,Grandt Simone,Greiner Wolfgang,Hammerschmidt Reinhard,Harder Sebastian,Ihle Peter,Jachmich Julia,Klaaßen-Mielke Renate,Leicher Eva,Lemke Dorothea,Meyer Frank,Meyer Ingo,Müller Beate S.,Müller Thomas,Perera Rafael,Pfaff Holger,Richard Johanna,Surmann Bastian,Timmesfeld Nina,Trampisch Hans J.,
Abstract
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.
Funder
The Innovation Fund of the German Federal Joint Committee
Bergische Universität Wuppertal
Publisher
Springer Science and Business Media LLC