Table 2 PEDDI Usability Problems and Redesign Solutions

1. Plan to obtain the data needed to make subgroup comparisons

Identify where the data will come from (e.g., download data from a population health management system linked to an electronic health record)

Staff do not know how to use data reporting tools

• Staff have not been trained or are not proficient in use of available data reporting tools in the electronic health record to generate the subgroup comparisons that will enable them to identify gaps in outreach and/or return of FIT kits

• Train and/or retrain staff to use the data reporting tools in the electronic health record to generate subgroup comparisons

Data on patient outreach for CRC is not routinely collected

• Data on patient outreach is not systematically collected in a way that can be examined in practice

• When data is collected, it does not get saved in the patient’s chart in a way that an analyst could use it to quantify outreach. This would require manual data collection

• There would be burden in understanding why the outreach did not happen

• Having unique data points for outreach for a single clinical measure is a burden when the CHC typically focuses on outreach for multiple measures

• Create a workflow to systematically track patient outreach activities

• Pull lists of patients for which a FIT was ordered

• Show the team evidence that examining gaps in outreach leads to improved outreach

• Examine outreach overall, not specific to CRC screening

2. Select variables for comparisons to identify gaps and obtain clinic data

Consider completeness and availability of data (e.g., Is the data routinely collected and available?)

Missing data on key variables

• Social determinants of health data may be missing

• When demographic data is collected it is not always complete

• Make data fields mandatory in the electronic health record

• Examine patient groups with missing data as their own group

• Find alternatives to asking the front desk staff to collect demographic data and other sensitive information

Delays in getting data reports

• Reports needed to identify patient gaps are not always available in a timely manner

• Use monthly reports on screening completions

Not feasible to evaluate more than one variable

• Examining data broken down by race and ethnicity combined, the cells are often too small to be able to see the story

• Examine broader categories of socioeconomic status or insurance type to capture a larger population

• Examine both broad categories and subgroups at risk within the categories

4. Identify and plan feasible adaptations to outreach and/or intervention to address the gaps prioritized in Step 3

Brainstorm with your healthcare team possible adaptations to the outreach and/or intervention

Difficult to find time for brainstorming with the healthcare team

• Getting everyone together as a team to brainstorm is difficult

• Iterative brainstorming would not be feasible in most cases

• Use an existing meeting time for brainstorming

• Form a subgroup to brainstorm on the specific topic

• Elicit ideas and perspectives from key individuals and compile the list of possible adaptations

• Perform root cause analysis to see which adaptation might have the most leverage

Identify whether adaptations will be made to the: 1) content, 2) training, or 3) other

Difficult to adapt strategies for a subpopulation

• Applying the same adapted outreach and/or intervention to an entire subpopulation may not be practical when clinicians are focused on tailoring care to the individual in front of them

• Provide clarity on the goal of the adaptation

Develop a list of resources, training, and/or approvals needed to make adaptations

Ideas for improvement can exceed resources

• Ideas generated during brainstorming sessions can exceed the scope of available resources

• Use a facilitator who can keep solutions within the project scope and available resources

• Identify trainings planned for other purposes and leverage those trainings for the project

5. Conduct rapid cycle testing of the planned adaptations

Determine how to test the adaptation on a small scale: identify which staff will be involved, assign responsibilities; develop documentation; develop data collection procedures

Barriers to performing rapid cycle testing

• Numerous barriers can get in the way of performing rapid cycle testing, including workforce shortages and competing demands

• Start with one team, make adaptations, if successful then develop training materials and rollout to the center

Examine the data collected on the adaptation. Determine whether the adaptation was successful, partially successful or not at all successful

Risk of losing momentum during adaptation process

• There is a risk of losing momentum among the team if the adaptations don’t have impact and it's not apparent what change you could make to try again

• Qualitative feedback about how it went can help keep the team on track, interested, and engaged

• Data on proximal indicators can help keep the team on track and moving forward