A Multisite CFIR Study of Readiness to Implement Collaboration Oriented Approach to Controlling High Blood Pressure (COACH)

<h3>Context:</h3> Evaluating organizational readiness for implementing digital health solutions can identify potential barriers and increase the likelihood of sustained adoption. In the context of hypertension management, the Collaboration Oriented Approach to Controlling High blood pressure (COACH) application intends to support guideline-based home blood pressure monitoring by providing patients and clinicians with visualizations and recommendations to achieve blood pressure goals and reduce risks of heart attacks and stroke. <h3>Objective:</h3> In preparation for a multisite pragmatic trial, we applied the Consolidated Framework for Implementation Research (CFIR) to evaluate sites9 readiness for implementation. <h3>Study design:</h3> Deductive qualitative analysis. <h3>Setting:</h3> Three academic health systems with EPIC and Oracle electronic health records. <h3>Population Studied:</h3> Primary care team members involved in high blood pressure management. <h3>Intervention:</h3> COACH — a patient-facing decision support tool integrated into the electronic record. <h3>Outcome Measures:</h3> Interview questions and analysis were guided by five CFIR domains (innovation source, inner and outer setting, individuals, and implementation process). Researchers qualitatively coded interview data for each domain, created summaries of findings, and then ranked sites on a scale of -2 to +2 for each domain. <h3>Results:</h3> 72 care team members at 9 clinics participated. CFIR scores were mostly positive (79%), indicating readiness and a climate conducive to COACH implementation; 8% of scores were negative. Cross-cutting CFIR domains, with a high degree of positive scoring influence, were organizational culture and mission, reflecting the commitment to improving care quality and health outcomes. Conversely, the COVID-19 pandemic, a critical incident, negatively affected all sites’ resources, capacity, and priorities but was seemingly more dramatic in two. Consideration of the care team workflows (i.e., teaming) was described as essential across sites, as it promotes care quality (e.g., timeliness and satisfaction) and decreases message center burden; people suggested the trial9s protocol emphasizes team-based approaches for recruitment and evaluation. COACH was embraced for its relative advantage over traditional workflows and its potential to empower and educate patients. <h3>Conclusion:</h3> COACH pre-implementation evaluation provided information that informed implementation and trial protocol changes and may increase the adoption of COACH.