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Making cognitive decision support work: Facilitating adoption, knowledge and behavior change through QI.

Charlene Weir1, Cherie Brunker2, Jorie Butler3

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Summary

Facilitation and specialized computerized decision support (CDS) improve clinician self-efficacy in geriatric care. This quality improvement program enhanced skills in areas like medication management and fall prevention, leading to better patient care.

Keywords:
CognitionDecision supportGeriatricsImplementation sciencePsychologySelf-efficacy

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Area of Science:

  • Health Services Research
  • Medical Informatics
  • Geriatric Medicine

Background:

  • Facilitation plays a key role in implementing Computerized Decision Support (CDS).
  • Self-efficacy is a proposed mediator for CDS effectiveness.
  • Quality Improvement (QI) projects can enhance geriatric care.

Purpose of the Study:

  • To evaluate the role of facilitation in implementing CDS for geriatric care.
  • To assess the impact of a QI program on clinician self-efficacy in geriatric care.
  • To examine the relationship between implementation support, facilitation, and perceived success.

Main Methods:

  • A 6-month QI-based intervention ('Advancing Geriatric Education through Quality Improvement' - AGE QI) was implemented in outpatient clinics.
  • The intervention included didactic sessions, QI planning, CDS design/implementation, facilitation, feedback, and continuing medical education (CME).
  • Pre/post surveys assessed clinician self-efficacy in caring for older adults using a Likert-based instrument.

Main Results:

  • Clinician self-efficacy improved across multiple geriatric care domains, including depression, falls, end-of-life care, functional status, and medication management.
  • Improvements were specifically noted in QI-targeted domains.
  • Enhanced self-efficacy was associated with overall clinic improvements.

Conclusions:

  • Facilitation, alongside CDS and QI, significantly enhances clinician self-efficacy in geriatric care.
  • The AGE QI program demonstrated success in improving clinicians' confidence and skills.
  • These findings support the integration of facilitation strategies into CDS implementation for better healthcare outcomes.