Coordinating Resources for a Hybrid Effectiveness and Implementation Trial Across an Integrated Digital Network

Abstract Background Technological innovation is revolutionizing the delivery of healthcare. Digital networks provide the infrastructure needed for multi-site interventions but increase the complexity of conducting these interventions. A pre-implementation investigation was conducted of an existing infrastructure, the Greater Plains Collaborative (GPC) an integrated digital network of electronic health record (EHR) systems of 12 leading health centers across 10 states in the Midwest. The purpose was to assess the processes through which effects can be achieved and priorities established to support a subsequent hybrid implementation and effectiveness trial for exercise adherence for adults with heart failure (HF). The objectives of this investigation were to: 1) engage the data coordinators at each site to query their EHR system to estimate the population of HF patients across the network, 2) evaluate the accessibility of the Patient Reported Outcome Measurement Information System (PROMIS) in the EHR, and 3) determine if the data requested could be reported in a complete and timely manner. Methods This retrospective study used a data query in REDCap distributed to the clinical data coordinators at each GPC network health system. Descriptive analysis was conducted. Results The data was collected from January 1, 2019–2021. The total number of adult patients age ≥ 18 years diagnosed with HF (ICD10:I50) who were receiving care at each of the GPC network institutions ranged from just under 500,000 to over 2,500,000. The mean number of adults with HF was 171,715 (range 4,279 − 36,856) across 10 sites. Ten health systems responded within 48 hours to our query. Only two (20%) of 10 sites reported PROMIS measures available in the EHR, six (60%) reported PROMIS measures accessible outside the EHR, and two (20%) were uncertain. Conclusions Future trials leveraging the infrastructure and resources of the existing GPC network can be enhanced by early identification of resources needed for knowledge translation. Coordination is essential to improve dissemination and implementation, and ultimately, to enhance adoption of guideline-directed exercise recommendations for adults with heart failure (HF) to realize the benefits. Establishing a clinical coordinating center and applying principles of program management is needed.