%0 Journal Article
%@ 1438-8871
%I JMIR Publications
%V 24
%N 8
%P e30902
%T Barriers and Facilitators to the Implementation of Family-Centered Technology in Complex Care: Feasibility Study
%A Lin,Jody L
%A Huber,Bernd
%A Amir,Ofra
%A Gehrmann,Sebastian
%A Ramirez,Kimberly S
%A Ochoa,Kimberly M
%A Asch,Steven M
%A Gajos,Krzysztof Z
%A Grosz,Barbara J
%A Sanders,Lee M
%+ Department of Pediatrics, University of Utah School of Medicine, 100 Mario Capecchi Drive, Salt Lake City, UT, 84114, United States, 1 801 662 3645, jody.lin@hsc.utah.edu
%K care coordination
%K implementation science
%K chronic illness
%K pediatric
%K family medicine
%K barrier
%K complex care
%K children
%K families
%K parents
%K care providers
%K chronic disease
%K coordination
%K implementation
%K improvement
%K technology
%K feasibility
%K acceptability
%K monitoring
%D 2022
%7 23.8.2022
%9 Original Paper
%J J Med Internet Res
%G English
%X Background: Care coordination is challenging but crucial for children with medical complexity (CMC). Technology-based solutions are increasingly prevalent but little is known about how to successfully deploy them in the care of CMC. Objective: The aim of this study was to assess the feasibility and acceptability of GoalKeeper (GK), an internet-based system for eliciting and monitoring family-centered goals for CMC, and to identify barriers and facilitators to implementation. Methods: We used the Consolidated Framework for Implementation Research (CFIR) to explore the barriers and facilitators to the implementation of GK as part of a clinical trial of GK in ambulatory clinics at a children’s hospital (NCT03620071). The study was conducted in 3 phases: preimplementation, implementation (trial), and postimplementation. For the trial, we recruited providers at participating clinics and English-speaking parents of CMC<12 years of age with home internet access. All participants used GK during an initial clinic visit and for 3 months after. We conducted preimplementation focus groups and postimplementation semistructured exit interviews using the CFIR interview guide. Participant exit surveys assessed GK feasibility and acceptability on a 5-point Likert scale. For each interview, 3 independent coders used content analysis and serial coding reviews based on the CFIR qualitative analytic plan and assigned quantitative ratings to each CFIR construct (–2 strong barrier to +2 strong facilitator). Results: Preimplementation focus groups included 2 parents (1 male participant and 1 female participant) and 3 providers (1 in complex care, 1 in clinical informatics, and 1 in neurology). From focus groups, we developed 3 implementation strategies: education (parents: 5-minute demo; providers: 30-minute tutorial and 5-minute video on use in a clinic visit; both: instructional manual), tech support (in-person, virtual), and automated email reminders for parents. For implementation (April 1, 2019, to December 21, 2020), we enrolled 11 providers (7 female participants, 5 in complex care) and 35 parents (mean age 38.3, SD 7.8 years; n=28, 80% female; n=17, 49% Caucasian; n=16, 46% Hispanic; and n=30, 86% at least some college). One parent-provider pair did not use GK in the clinic visit, and few used GK after the visit. In 18 parent and 9 provider exit interviews, the key facilitators were shared goal setting, GK’s internet accessibility and email reminders (parents), and GK’s ability to set long-term goals and use at the end of visits (providers). A key barrier was GK’s lack of integration into the electronic health record or patient portal. Most parents (13/19) and providers (6/9) would recommend GK to their peers. Conclusions: Family-centered technologies like GK are feasible and acceptable for the care of CMC, but sustained use depends on integration into electronic health records. Trial Registration: ClinicalTrials.gov NCT03620071; https://clinicaltrials.gov/ct2/show/NCT03620071 
%M 35998021
%R 10.2196/30902
%U https://www.jmir.org/2022/8/e30902
%U https://doi.org/10.2196/30902
%U http://www.ncbi.nlm.nih.gov/pubmed/35998021