Information system support as a critical success factor for chronic disease management
The authors conducted a qualitative study of critical success factors that enabled a group of thirty primary care physicians in Victoria British Columbia to adopt evidence based practices for the care of chronic diseases at a higher adoption rate than their peers. The physicians were able to demonstrate a remarkable improvement in care for chronic conditions for example having the proportion of diabetic patients with HbA1c under 8% increase from 62% to 88% within one year and several other significant changes. The clinicians were self responders to a recruitment effort for a project that provided them with a secure web-based informatics tools for Chronic Diseased Management. Most of these clinicians had paper records, but were clearly self-selected and motivated. These tools included a secure web portal, evidence-based guidelines for the conditions of interest and a predefined quality improvement process.
The authors performed key informant interviews and utilized structured observation to develop a transcript that was coded and analyzed. Critical success factor analysis was performed, which identified seven components that were considered by participants as critical to success. These factors were: 1) Formal knowledge translation that starts by outlining current suboptimal outcomes 2) Models for evidence-based chronic care delivery, 3) Partnerships between government, physicians and administration 4) Innovative funding methods that encourage the adoption of the technology and the acquisition of evidence-based knowledge 5) Strong physician, group and IT project management, 6) A comprehensive health delivery system that focuses on and understands the needs of a patient with chronic disease and is ready for reform., , 7) Having a centralized information and communication technology systems and support. It is also important to have a Quality Improvement framework as the central tenet in order to organize all of the other factors of success.
The authors also note that the Information system developed was critical to help aid in the collections and maintenance of data, the necessary reporting and the communication amongst all members of the team. Information delivered via this system included some audit and feedback data, as well as targeted alerts and reminders regarding individual clinicians, their patients and adherence to evidence based guidelines for chronic illness. It was felt that this provided one of the most important tools to the primary care clinicians, but that all of the other factors were also required.
The authors concluded that these direct critical success factors were all needed in order to observe the dramatic enhancement in outcomes that were observed. In addition they postulated that a meta-success factor in this particular project was the “executive sponsorship” it received from the Canadian government and the University of Victoria researchers.
It appears that the primary care physicians were able to make a remarkable leap forward in the measured quality of care that they were able to document within one year of starting in this project. While the absolute improvement in care reported is somewhat astounding it would need to be duplicated to understand how easy it is to generalize this study. The seven inter-related success factors seem very logical, yet very infrequently discussed when outlining plans to implement a informatics intervention. It would be wise to attempt to emulate many of the success factors noted above as implementation plan is developed.