Table 3 Integration strategies: name and definition (14)

Access new funding

Access new or existing money to facilitate the implementation

Alter incentive/ allowance structures

Work to incentivize the adoption and implementation of the clinical innovation

Alter patient/consumer fees

Create fee structures where patients/consumers pay less for preferred treatments (the clinical innovation) and more for less-preferred treatments

Audit and provide feedback

Collect and summarize clinical performance data over a specified time period and give it to clinicians and administrators to monitor, evaluate, and modify provider behavior

Build a coalition

Recruit and cultivate relationships with partners in the implementation effort

Change accreditation or membership requirements

Strive to alter accreditation standards so that they require or encourage use of the clinical innovation. Work to alter membership organization requirements so that those who want to affiliate with the organization are encouraged or required to use the clinical innovation

Change liability laws

Participate in liability reform efforts that make clinicians more willing to deliver the clinical innovation

Change physical structure and equipment

Evaluate current configurations and adapt, as needed, the physical structure and/or equipment (e.g., changing the layout of a room, adding equipment) to best accommodate the targeted innovation

Change record systems

Change records systems to allow better assessment of implementation or clinical outcomes

Change service sites

Change the location of clinical service sites to increase access

Create new clinical teams

Change who serves on the clinical team, adding different disciplines and different skills to make it more likely that the clinical innovation is delivered (or is more successfully delivered)

Create or change credentialing and/or licensure standards

Create an organization that certifies clinicians in the innovation or encourage an existing organization to do so. Change governmental professional certification or licensure requirements to include delivering the innovation. Work to alter continuing education requirements to shape professional practice toward the innovation

Develop disincentives

Provide financial disincentives for failure to implement or use the clinical innovations

Develop resource sharing agreements

Develop partnerships with organizations that have resources needed to implement the innovation

Facilitate relay of clinical data to providers

Provide as close to real-time data as possible about key measures of process/outcomes using integrated modes/channels of communication in a way that promotes use of the targeted innovation

Fund and contract for the clinical innovation

Governments and other payers of services issue requests for proposals to deliver the innovation, use contracting processes to motivate providers to deliver the clinical innovation, and develop new funding formulas that make it more likely that providers will deliver the innovation

Increase demand

Attempt to influence the market for the clinical innovation to increase competition intensity and to increase the maturity of the market for the clinical innovation

Make billing easier

Make it easier to bill for the clinical innovation

Mandate change

Have leadership declare the priority of the innovation and their determination to have it implemented

Place innovation on fee for service lists/formularies

Work to place the clinical innovation on lists of actions for which providers can be reimbursed (e.g., a drug is placed on a formulary, a procedure is now reimbursable)

Prepare patients/consumers to be active participants

Prepare patients/consumers to be active in their care, to ask questions, and specifically to inquire about care guidelines, the evidence behind clinical decisions, or about available evidence-supported treatments

Provide clinical supervision

Provide clinicians with ongoing supervision focusing on the innovation. Provide training for clinical supervisors who will supervise clinicians who provide the innovation

Remind clinicians

Develop reminder systems designed to help clinicians to recall information and/or prompt them to use the clinical innovation

Revise professional roles

Shift and revise roles among professionals who provide care, and redesign job characteristics

Use capitated payments

Pay providers or care systems a set amount per patient/consumer for delivering clinical care

Use data warehousing techniques

Integrate clinical records across facilities and organizations to facilitate implementation across systems

Use mass media

Use media to reach large numbers of people to spread the word about the clinical innovation

Use other payment schemes

Introduce payment approaches (in a catch-all category)