Table 3.
Identified themes and subthemes (n=22).
| Themes and subthemes | Participants, n (%) | |||
| How could the tool affect the delivery of care? | ||||
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This tool has the potential to be useful because it provides information that is not currently available and can make care more efficient and effective | |||
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The tool is not currently available, addresses a clinical gap, and represents a departure from the status quo. | 7 (32) | |
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Clinicians and staff would increase their focus on diabetes, by scheduling more frequent visits, interacting with patients in between visits, managing diabetes even when acute issues emerge, and providing targeted education. | 20 (91) | |
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This tool could improve population health, address quality measures, and contribute to efficient resource allocation. | 10 (45) | |
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The tool would facilitate individualized and holistic care, by integrating primary care, behavioral health, and social care. | 11 (50) | |
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Participants were ambivalent about the tool’s impact on populations that have been made susceptible. Some participants thought these were the patients who needed attention the most, whereas others thought that making a positive impact would be difficult. | 7 (32) | |
| What concerns do clinicians and staff have about the tool? | ||||
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Clinicians and staff were concerned about how the tool affects patient-oriented outcomes and clinic workflows | |||
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Participants were concerned the tool would lead to harms, contribute to overdiagnosis, be used punitively, and make care more expensive. | 15 (68) | |
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The utility is limited for those clinicians who know their patients well or have access to existing programs, and some would rather focus on people who are already uncontrolled. | 8 (36) | |
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Participants were concerned that the tool would exacerbate existing problems, such as health disparities and alert fatigue. | 14 (64) | |
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Participants were concerned that the tool’s accuracy and implementation were not supported by evidence. | 5 (23) | |
| What changes would increase adoption? | ||||
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Adoption of the tool is dependent on its validation, transparency, actionability, and design and could be increased with changes to the interface and usability | |||
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The tool needs to be validated against patient-oriented outcomes so that clinics can quantify the potential return on their investment. | 4 (18) | |
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Knowing how the tool was developed and the rationale behind why an individual is high risk allows clinicians and staff to gauge the tool’s credibility. | 11 (50) | |
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To act on the information, clinicians and staff need to understand which risk factors are modifiable and which actions will have the greatest impact on lowering risk. | 6 (27) | |
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Using user-centered design principles has the potential to minimize the tool’s impact on workflows and maximize readability. | 13 (59) | |
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The ability to customize the tool is important because implementation could differ across practices and clinicians. | 2 (9) | |
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Participants recommended integrating functionality and relevant information from within the EHRa. | 19 (86) | |
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Participants recommended other events that could be predicted, including cardiovascular disease, uncontrolled hypertension, worsening depression, care gaps (eg, preventive services), and missed appointments. | 22 (100) | |
| What factors would affect implementation? | ||||
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Implementation would require buy-in and need to be tailored to the demands and resources of clinics and communities | |||
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The local context affects what can be done in response to the information provided by the tool. Conversely, participants will become frustrated if the tool recommends an option that is not available. | 12 (55) | |
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Responding to the tool in a comprehensive manner requires the engagement of a comprehensive team. Although there was strong consensus regarding the role of clinicians and nurses, participants expressed ambivalence regarding administrators and patients. | 21 (95) | |
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Participants wanted to share this information with patients to empower them and support transparency but were also concerned that the information would cause confusion and stress. | 20 (91) | |
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There was a lack of consensus regarding when the alert should appear, with some wanting it at the point of care, whereas others wanted to review the information outside of visits (eg, periodic lists or a dashboard). | 17 (77) | |
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Successful implementation would require trialability, training, interoperability, and buy-in. | 8 (36.) | |
aEHR: electronic health record.