Translating Clinical Informatics Interventions into Routine Clinical Care: How Can the RE-AIM Framework Help?

What proportion of eligible patients was offered the Choice intervention at outpatient consultations, at admission, during hospital stay, or in preparation for discharge?

Which patients did not receive the intervention and why?

Were the patients who used or did not use the intervention representative of those eligible to use it?

What proportion of nurses and physicians actively use Choice assessment summaries to support patient-centered care and patient provider-communication?

Does Choice use vary by practice settings, and if so, why?

What proportion of nurses eligible to use the DSS actually used it?

In what proportion of eligible patient encounters was the DSS used?

Were the nurses who used the DSS representative of those eligible to use it?

Were the patient encounters in which the DSS was used representative of the eligible patient encounters?

What is the effect of Choice on system outcomes (e.g., work processes; organizational change; interdisciplinary collaboration)?

What is the effect of Choice on provider outcomes (e.g., quality of care, congruence between symptoms reported and addressed, patient-provider communication, satisfaction)?

What is the effect of Choice on patient outcomes (e.g., symptom distress, quality of life, self-efficacy, satisfaction, participation in care)?

In what proportion of eligible encounters did screening for depression, obesity, or smoking occur?

Were there differences in the number of guideline-related diagnoses in DSS versus no DSS group?

Were there differences in the number of guideline-related interventions in DSS versus no DSS group?

What are the characteristics of the settings who decided to adopt Choice?

How well did the goals and values of Choice fit with the values and expectations of patients, nurses, and physicians?

How well did the goals of Choice fit with the values and expectations of the practice settings?

What proportion of patient encounters in DSS versus no DSS groups involved those who were Hispanic, African-American, or lacked private medical insurance?

Did DSS use help the Columbia University School of Nursing achieve its educational and practice missions?

Did DSS use help specific clinical practice sites achieve their practice missions?

How many nurses and physicians used Choice?

Did Choice use vary by unit?

Was Choice used as originally intended?

Did users perceive Choice as easy to use? (predisposing)

Did users perceive Choice as useful? (predisposing)

Was there sufficient leadership support and user buy-in? (predisposing)

What measures were needed to improve readiness for Choice adoption, commitment, and buy-in of practice settings? (enabling)

How were end-users involved in the Choice implementation process? (enabling)

What workflow adjustments needed to be made to streamline Choice into routines of daily clinical practice? (enabling)

What adjustments needed to be made to the Choice application itself? (enabling)

What were the confidentiality and data security issues when integrating Choice into routine practice and how were they addressed? (enabling)

What support, resources and outside collaborations were needed to implement Choice? (enabling)

Were the necessary resources and support available? (enabling)

What were the educational needs of Choice users? (enabling)

What were the potential barriers to successful Choice implementation and how were they addressed? (enabling)

How many nurses used the DSS?

Did DSS use vary according to time in Master's educational program?

Did DSS use vary by nursing specialty?

Did DSS use vary by guideline (depression versus obesity versus smoking cessation)?

Were DSS functions (screening, assessment, diagnosis, guideline-based plan of care template) used as intended?

What level of general PDA knowledge and DSS-specific knowledge was needed to use the DSS? (predisposing)

Did users perceive the DSS as easy to use? (predisposing)

Did users perceive the DSS as useful? (predisposing)

What user training and support services were needed by DSS users? (enabling)

What technical infrastructure was required to implement the DSS? (enabling)

How did Choice evolve over time?

Did Choice produce lasting effects at individual level?

Did the units sustain Choice use over time?

What efforts were needed to maintain participation rate and effectiveness (e.g., repeated educational sessions concordant with staff turnover)? (reinforcing)

How did the DSS evolve over time?

Which reinforcing factors were useful (e.g., individual reports, aggregate reports by specialty, booster training sessions)?