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APHA Scientific Session and Event Listing

Mari Millery, PhD¹, Nadine Nader¹, Daniel Schluter, PhD¹, and Peter Messeri, PhD². (1) Columbia University, 722 West 168th Street, Room 11-14, New York, NY 10032, 212-305-3891, nn69@columbia.edu, (2) Sociomedical Sciences, Columbia University, 722 West 168th Street, New York, NY 10024

Background: Many public health innovations, including tools, technologies, practice models etc., are not effectively diffused into community health settings. Systematic analysis of barriers to introducing and implementing innovation in these settings is needed to improve the diffusion process for tools that have potential for improving quality of care. Our research study introducing and implementing a web-based information tool for HIV providers, HIV TIPS, into 24 clinics in poor and underserved communities illustrates major barriers in this process.

Methods: Data were collected as part of a multi-method information technology needs assessment that included structured provider interviews, semi-structured key informant interviews with clinic management and on-site observation.

Results: Only 14% of 148 clinics initially approached were enrolled in the study. The most frequent reasons for refusal were perceived lack of time or need for the tool, and recruiters frequently faced complex hierarchies of stakeholders to be convinced. On the institutional level, a formal network of clinics and substantial monetary compensation facilitated buy-in while an HIV training center did not. Implementation, consisting of a brief training session, was hampered by pace of patient care activities that leaves no room for learning new tools and leads to scheduling difficulties, high level of staff turnover and problems with technology infrastructure and support.

Conclusions: Bringing innovation effectively to community health settings requires understanding the nature of these settings and adapting implementation strategies. The lessons learned from HIV TIPS are particularly relevant in light of the national plan to implement electronic medical records across health care settings.

Learning Objectives:

• Learn about characteristics of community health clinics that interfere with innovation implementation.
• Understand challenges in implementing innovation in community health clinics.
• Lessons learned from the HIV TIPS study that can be applied to planning of innovation implementation.

Presenting author's disclosure statement:

Not Answered