Table 2.
Agreed-Upon ERIC Implementation Strategies for Barriers to Implementation by 5 CFIR Domains
| ERIC Strategies | Barriers categorized into CFIR Domains | ||||
|---|---|---|---|---|---|
| Inner Setting1 |
Outer Setting2 |
Intervention Characteristic3 |
Characteristics of Individuals4 |
Process5 | |
| Assess for readiness and identify barriers and facilitators | C | C | C | ||
| Develop a formal implementation blueprint | IS&C | IS&C | |||
| Conduct local needs assessment | C | C | C | ||
| Obtain and use patients/consumers and family feedback | IS&C | ||||
| Facilitation | IS | IS | IS | IS | IS |
| Provide local technical assistance | IS&C | C | |||
| Tailor strategies | IS&C | ||||
| Promote adaptability | IS&C | ||||
| Use data experts | IS | IS | |||
| Identify and prepare champions | IS&C | IS&C | IS&C | IS&C | |
| Organize clinician implementation team meetings | IS&C | C | |||
| Recruit, designate, and train for leadership | IS | IS | |||
| Inform local opinion leaders | IS | IS | IS | IS | |
| Build a coalition | IS&C | IS | IS | C | |
| Identify early adopters | IS&C | IS | IS&C | ||
| Conduct local consensus discussions | IS | IS&C | IS | ||
| Capture and share local knowledge | IS | ||||
| Model and simulate change | IS&C | IS | |||
| Visit other sites | IS | ||||
| Conduct ongoing training | IS&C | IS | |||
| Provide ongoing consultation | IS | IS | |||
| Develop educational materials | IS | IS&C | IS | ||
| Make training dynamic | C | C | |||
| Distribute educational materials | IS | IS | IS | ||
| Conduct educational meetings | IS&C | C | IS&C | IS&C | |
| Conduct educational outreach visits | IS | IS | |||
| Shadow other experts | IS | ||||
| Facilitate relay of clinical data to providers | IS | IS | |||
| Revise professional roles | IS&C | ||||
| Involve patients/consumers and family members | IS&C | IS | |||
| Intervene with patients/consumers to enhance uptake and adherence | IS | IS | IS | IS | |
| Prepare patients/consumers to be active participants | C | IS&C | IS | ||
| Fund and contract for the clinical innovation | C | ||||
| Access new funding | IS | IS | |||
| Place innovation on fee for service lists/formularies | IS | ||||
| Alter incentive/allowance structures | IS | ||||
| Alter patient/consumer fees | IS&C | ||||
| Use other payment schemes | IS | ||||
| Change record systems | IS&C | ||||
Abbreviations: CFIR, Consolidated Framework for Implementation Research; ERIC, Expert Recommendations for Implementing Change; C, ERIC strategies agreed upon by C only; IS&C, ERIC strategies agreed upon by both implementation scientists (IS) and clinicians (C); IS, ERIC strategies agreed upon by IS only.
Inner Setting barriers: time constraints, accessibility to risk calculator/electronic health record integration, buy-in, documented workflow, calculator training, staffing issues, clinical champion, team communication.
Outer Setting barriers: patient fears (e.g., statin side effects), patient issues with costs of medications.
Intervention Characteristics barriers: buy-in, trust in guidelines (by clinicians), patient population (i.e., perceived limited population at risk for cardiovascular disease), results vary by calculator.
Characteristics of Individuals barriers: buy-in, calculator training.
Process barriers: documented workflow, clinical champion.